Cervical nucleoplasty as an effective treatment method of cervical degenerative disc disease

provided the original work is properly cited. CC Nucleoplasty is a minimally invasive spine intervention technique that uses controlled ablation, known as coblation to decompress the protruded intervertebral disc. Due to its short history and narrow indications, there is limited evidence concerning the efficacy and clinical outcome of cervical nucleoplasty. However, recent clinical experiences show that cervical nucleoplasty is a safe, convenient procedure with an excellent short-term clinical outcome. A previously healthy 38-year-old male visited our clinic with numbness of the lateral part of his left lower arm and shoulder, tingling sensation and pain of his left thumb in which he has been suffering for 2 years. He showed no neurologic deficit. He rated his pain level as 8 out of 10 cm on the visual analogue scale (VAS). He received physical therapy and acupuncture for 2 years, but showed no improvement. Initial MRI study showed C4-5 disc extrusion, C5-6 disc protrusion and mild bulging of C6-7 disc (Figs. 1A-1D). He was scheduled for nucleoplasty of C5-6 disc. No analgesic medications were prescribed. Prior to procedure, 1.0 g cefazolin was given intravenously as prophylaxis. Patient was placed on supine position on the operation table with his neck hyperextended. Vital signs were monitored and oxygen was supplied at 5 L/min via nasal prong. The position and angle of the herniated part of the disc from the center of the disc was measured from the MRI. The C-arm was tilted obliquely to the opposite side of the patient’s symptoms, according to the angle measured from the MRI. The needle entry point was marked on the right side of the patient at the center of the C5-6 disc level. The right internal carotid artery was displaced with the operator’s fingers. The needle was advanced to the anterolateral annulus fibrosus. Local anesthetic (5 ml of 2% lidocaine) was given from the disc to the skin, while repeated aspiration was performed. Displacing the right internal carotid artery, a 19 G 3 inch introducer needle (ArthroCare Co., Sunnyvale, CA, USA) was advanced until it reached the annulus fibrosus of the C5-6 disc. The position of the needle tip was confirmed by the C-arm. Introducer needle was directed toward the center of the C5-6 disc to guide the estimated progression route under the oblique view of the C-arm. After withdrawing the stylet, the Perc DC Spine Wand (ArthroCare Co., Sunnyvale, CA, USA) was fastened to the needle hub. We advanced the introducer needle and Perc DC Spine Wand to the estimated lesion. The Perc DC Spine Wand was connected to the Arthrocare system 2000 (ArthroCare Co., Sunnyvale, CA, USA), and coagulation was tested with the radio-frequency controller set for 1 to 2 seconds to check if there was movement or paresthesia in the patient’s upper limbs. Checking the needle position by the lateral view of C-arm, coblation was performed for 15 seconds, while rotating the tip by 180 degrees, and repeated 3-4 times. Then, the tip was withdrawn a few milimeters, and repeated the same way above. The last coblation was performed when the tip of the needle was placed at the middle part of the disc in the lateral view of the Carm (Figs. 1E and 1F). The patient felt no discomfort during the procedure. After the procedure, the patient took an absolute bed rest for four hours. One day after the procedure, the patient showed