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Chulalongkorn Medical Journal

Abstract

Introduction : Nucleoplasty is a minimally invasive percutaneus lumbar intervertebraldisk decompression using coblation energey. The technique isindicated for patients with contained herniated lumbar disk who areunresponsive to conservative management as an alternative treatment.Many recent literatures proved that nucleoplasty is an effectiveprocedure comparable to the standard treatment, but its long-termresult is still controversial.Objective : To compare effectiveness between nucleoplasty and conventionalopened diskectomy and to evaluate the economical aspects ofnucleoplastySetting : Department of Orthopaedics, King Chulalongkorn Memorial Hospital.Research Design : A non-randomized prospective clinical trial with full economicevaluationPatients : Contained lumbar intervertebral disk herniation patients with radicularpain who had undergone diskectomy and nucleoplasty at KingChulalongkorn Memorial Hospital from 2004 to 2006Methods : Thirty-four patients were recruited; twenty into nucleoplasty group andfourteen diskectomy group. Surgical techniques used were based onthe patient’s decisions. Pain intensity using 10 cm visual analoguescale and direct medical cost from King Chulalongkorn MemorialHospital computer data base was collected. The data were analyzedusing paired and unpaired student t-test for effectiveness. Costeffectiveanalysis and sensitivity analysis were done to evaluatethe economic aspects.Results : The success rate is 70% in the nucleoplasty group and 86% inthe diskectomy group. Both techniques significantly decrease paincompared with the preoperative status. Diskectomy decreases painmore than nucleoplasty in the first month. There is no difference inthe overall pain reduction. Cost of nucleoplasty is higher than diskectomy8,225 bath net and 2,600 per 1 visual analogue scale pain reduction.Regarding sensitivity analysis, however, patients whose income ismore than 1,750 baht/day are suitable to choose nuceloplasty.Conclusions : From the current data we found that for carefully selected containedintervertebral disk patients caused by radicular encroachment whofailed conservative treatment, nucleoplasty provided substantialbenefit from minimally invasive technique and it is comparablebetween the conventional opened diskectomy and nucleoplasty in termof effectiveness and economy.

Publisher

Faculty of Medicine, Chulalongkorn University

First Page

307

Last Page

316

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