Predictive Factors of Successful Percutaneous Cervical Nucleoplasty for the Treatment of Pain with Cervical Herniated Disk.

Abstract

Percutaneous cervical nucleoplasty (PCN) is an effective treatment for cervical herniated intervertebral disc (C-HIVD). In this retrospective study, we evaluated clinical predictors that affect the successful outcome of PCN. Fluoroscopically guided PCN was conducted for C-HIVD by one pain physician. Successful outcome was defined as a combination of greater than 50% pain relief on the numerical rating scale pain score, no increase in analgesics, and no cervical epidural steroid injection during the 3-month follow-up period. The relationship between outcomes and independent variables, including patient demographics, comorbid diseases, pain duration, type of disc herniation, presence of spinal stenosis, pain location, analgesics, and shape of the PCN needle tip, were investigated using multivariable analyses. Of 201 patients, 134 experienced a successful outcome after PCN. In the positive outcome group, shorter pain durations, rarer central canal stenosis, increased unilateral radiculopathy versus axial pain, and more frequent use of the curved tip technique, were reported. Multivariable analyses revealed that unilateral radiculopathy (P = 0.013) and use of the curved-tip technique (P = 0.027) were independent positive predictors of successful PCN outcomes; conversely, longer pain duration (P = 0.014) and concurrent spinal stenosis (P < 0.001) were negative predictors. No serious complications related to PCN occurred. In this study, the success rate of PCN was 66.7% in patients with C-HIVD. Shorter pain duration, the absence of cervical central canal stenosis, pain location (i.e., unilateral radiculopathy vs. axial pain), and the use of the curved-tip technique were positive predictors of successful PCN.