Percutaneous nucleoplasty for non-specific low back pain: long-term follow up results

English Keywords:Department of Othopaedics, Beijing Army General Hospital, 100700, China

English Abstract:

  【Abstract】 Objectives: To evaluate the efficacy of percutaneous nucleoplasty for chronic low back pain through a long-term follow-up. Methods: From September 2004 to November 2006, a total of 172 patients suffering from chronic low back pain underwent percutaneous nucleoplasty in our department. 41 of 172 cases were followed up for an average of 67 months(range: 60-84 months). A total of 58 levels including L3/4 in 1 patient, L4/5 in 25 patients, L5/S1 in 2 patients, L3/4 and L4/5 in 2 patients, L4/5 and L5/S1 in 7 patients, L3/4, L4/5 and L5/S1 in 4 patients was involved. The outcome was clinically assessed before surgery, 1 week, 1 year, 3 years and 5 years after operation. Visual analogue scale(VAS), Oswestry disability index(ODI) questionnaire and subjective global rating of overall satisfaction by using modified MacNab criteria(only post-operative) were recorded and analyzed retrospectively. Results: All surgeres were successfully performed, postoperative discitis was noted in 1 case, which was resolved after conservative treatment. The VAS at differ?鄄ent time point was 7.9±0.7(pre-operative), 3.4±0.5(1 week post-operative), 2.5±0.7(1 year post-operative), 2.9±0.4(3 years post-operative) and 2.5±0.4(5 years post-operative), while the ODI score was 58.9±6.1, 42.1±4.2, 25.8±3.8, 25.4±4.0, and 23.0±2.9 respectively at corresponding time point. For both VAS and ODI score, there were significant differences compared with the preoperative, 1 week postoperative and 3 years postoperative(P＜0.05) and no significant difference was found between 3 years postoperative and 5 years postoperative. No statistic differences on age, gender, clinical symptoms were noted. Significant differences were found in preoperative disc height, MRI classification of disc degeneration and the results of provocative discography. 81% of the patients with 1 level involved showed excellent and good outcome after surgery, while only 42% of the patients with more than 2 levels involved showed the same results. According to the Macnab standard, 87.9% of the patients achieved excellent and good outcomes 1 week after surgery, and the rate of excellent and good outcomes were 72.4% at 1 year postoperatively, 67.7% at 3 years postoperatively and 63.1% at final follow-up. Conclusions: Percutaneous nucleoplasty generally is safe, effective and simple for the treatment of discogenic low back pain, especially in well selected cases. The results of medium-term and short-term seem to be satisfactory, but there is a significant decline of patients′ satisfaction after long-term follow-up.