COLD PLASMA NUCLEOPLASTY VERSUS RADIOFREQUENCY ANNULOPLASTY FOR DISCOGENIC PAIN SYNDROME: COMPARATIVE ANALYSIS OF EFFICACY

Introduction. The intervertebral disc is considered the main source of pain syndrome in degenerative diseases  of the spine. The methods of laser, mechanical and cold plasma nucleotomy are widely used in Russia and are included into the system of high-tech medical care. The most promising annuloplasty methods are less known and have only recently been introduced into the national surgical practice. patients’ selection criteria and surgical procedure choice are not clearly defined and the information about annuloplasty in the national literature is practically not presented.

Purpose — to conduct the comparative analysis for efficiency of paracentetic nucleoplasty and radiofrequency annuloplasty for discogenic pain and to identify the factors determining the surgery outcomes.

Materials and Methods. The authors performed a retrospective cohort study. patients were divided into two groups: 107 patients underwent cold plasma nucleoplasty (Np), 72 patients received radiofrequency annuloplasty (RFap) at one or several levels. evaluation of outcomes was based on the dynamics of the NRS-11 digital pain scale and the Oswestry index (OdI). Positive results were recognized with decrease of NRS-11 index by 50% (or NRc-11 <4) and OdI by 20% from the original (or OdI <20%) when the outcome was preserved for 6 or more months postoperatively. To identify the factors influencing the outcome the authors assessed the following criteria prior to surgery: clinical findings (acute, chronic or recurrent pain syndrome), severity and prevalence of disc degeneration at the level of intervention and in adjacent segments, the use of other interventional diagnostic methods for excluding other sources of pain.

Results. In results of the procedures the authors reported a decrease of indices in both groups (p<0.001) in the absence of significant differences between the groups (p = 0.672). However, but the number of positive outcomes in the RFap group was higher than in the Np group — 49 (68.1%) and 55 (51.4%) respectively. Significant prognostic factors in the Np group were acute character of the pain syndrome (Spearman ρ = 0.252, p = 0.014), fewer operated levels (ρ = -0.304, p<0.001); in both groups such factors were failure of other procedures (Np ρ = 0.413, p<0.001; RFap ρ = 0.464, p<0.001) and the degree of disc degeneration of adjacent segments (Np ρ = -0.387, p<0.001; RFap ρ = -0.297, p<0.001). With regression analysis the best results were observed under the criteria “failure of other procedures”,  for Np (OR 0.77 at 95% cI (0.682-0.857) and for RFap (OR 0.81, 95% cI (0.701-0.924)).

Conclusion. Both methods of cold plasma nucleoplasty and radiofrequency annuloplasty demonstrate positive and similar outcomes provided the discogenic character of the pain syndrome has been defined correctly. The most significant is the exclusion of other sources of pain by diagnostic blockades, especially for patients with chronic pain syndrome and advanced multi-level lesion of the spine segments.