Cervical nucleolysis: indications, technique, results. 190 patients

Area of Science:

• Neurosurgery
• Minimally Invasive Procedures
• Spinal Therapeutics

Background:

• Percutaneous techniques are established for lumbar disc herniation but less common in the cervical spine due to anatomical complexity and safety concerns.
• Cervical disc herniation can cause radiculalgia by compressing nerve roots, often due to free disc fragments.
• Existing treatments include microsurgery, but minimally invasive alternatives are sought for refractory cases.

Purpose of the Study:

• To evaluate the efficacy and safety of cervical nucleolysis for treating cervicobrachial neuralgia (CBN) in young patients.
• To compare the therapeutic value of cervical nucleolysis with traditional surgical interventions for cervical disc herniation.
• To establish cervical nucleolysis as a viable alternative for disc herniations resistant to conservative medical management.

Main Methods:

• Cervical nucleolysis involves the percutaneous injection of an enzyme (chymopapain) to dissolve herniated disc material.
• The procedure targets disc fragments compressing nerve roots within the vertebral canal or foramen.
• Patient selection is based on recurrent or medically resistant radiculalgia, with a focus on young individuals.

Main Results:

• Cervical nucleolysis has demonstrated remarkable effectiveness in treating cervicobrachial neuralgia.
• The technique provides rapid pain relief, making it competitive with established microsurgical procedures.
• The simplicity and effectiveness of nucleolysis have led to its increasing adoption over traditional surgery for suitable cases.

Conclusions:

• Cervical nucleolysis is a highly effective and safe minimally invasive treatment for young patients with cervical disc herniation causing radiculalgia.
• This enzyme-based procedure offers a valuable alternative to surgery, providing rapid symptom resolution.
• The technique is particularly beneficial for transligamentous disc fragments and cases resistant to conservative care.