CAM versus nucleoplasty

Summary

In recent years the general trend in spinal surgery has been reduction and minimalization.

In general, all these have shown a moderate or good clinical result but they have been associated with serious sequelae. Plasma-mediated electrosurgery, widely used in other medical fields, has demonstrated to be well suited for this new indication. To perform the Nucleoplasty (Coblation) and the CAM (Coblation-Assisted Microdiscectomy) is use the Perc-DLE SpineWand connected to a System 2000 generator (ArthoCare Corp., Sunnyvale, CA) was used. The device functions via plasma-mediated electrosurgery (Coblation) and differs from traditional electrosurgery.

From a small sample 64 operated patients with contained disc herniation were analysed and classified into those who underwent percutaneous disc decompression (PDD) using coblation technology and patients who underwent CAM. All patients who presented with PDD were considered candidates for open surgery but all of them opted for the new technique. There was no contraindication. They had discogenic low back pain and/or leg pain and the procedure was performed on an outpatient basis. Follow-up data was of 1 to 12 months. Patients’ gender distribution for PDD was 65% (41,6) male, 35% (22,4) female with a mean age of 43 years. The average duration of pain before nucleoplasty was of 18 months and none of them had previous lumbar surgery. At 6 to 12 months, 80% of the patients demonstrated an improvement in pain scores (75% very good, 5% good, 15% improved but not good, and 5% no effect). None of the patients was worse. Results indicate that Nucleoplasty may be an efficacious minimally invasive technique for the treatment of symptoms associated with contained herniated disc. However, randomized controlled studies are required to know with more precision the role of this procedure. CAM procedure (13 cases) is an excellent method in cases of root compression that needs liberation or in spine stenosis.