The risks and benefits of percutaneous nucleotomy for lumbar disc herniation - A ten-year longitudinal study

Percutaneous nucleotomy is a relatively new technique for treating lumbar d isc herniation. There is no agreement as to the volume of disc material to be removed. A long-term study of clinical and radiological data from patien ts treated by percutaneous nucleotomy was designed to identify the factors associated with favourable and unfavourable outcomes. We studied 42 patient s for at least ten years; the mean follow-up was 10.9 years, They were divi ded into two subgroups to assess the value of preserving the nucleus pulpos us in the central area of the disc. The overall success rate for both subgroups was 50%, A decrease in disc hei ght on plain radiography and a decrease in signal intensity on MRI were obs erved more infrequently in patients in whom the nucleus pulposus in the cen tral area of the disc had been preserved, than in those in whom it had been extensively removed. These adverse radiological findings correlated closel y with increased low back pain during the first one to two years after oper ation and a poorer overall outcome. We conclude that percutaneous nucleotomy is most likely to be successful wh en the central area of the disc is preserved.