Cover Page

Cite item


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. 

About the authors

I. V. Volkov

Vreden Russian Research Institute of Traumatology and Orthopedics ; Nikiforov National Center for Emergency and Radiation Medicine .

Author for correspondence.
8, ul. Akad. Baykova, 195427, St. Petersburg; 4/2, ul. Akad. Lebedeva, 194044, St. Petersburg. Russian Federation

I. Sh. Karabaev

Nikiforov National Center for Emergency and Radiation Medicine .

4/2, ul. Akad. Lebedeva, 194044, St. Petersburg. Russian Federation

D. A. Ptashnikov

Vreden Russian Research Institute of Traumatology and Orthopedics ; Mechnikov North-Western State Medical University .

8, ul. Akad. Baykova, 195427, St. Petersburg; 41, Kirochnaya ul., 191015, St. Petersburg. Russian Federation

N. A. Konovalov

Burdenko National Scientific Practical Center of Neurosurgery.

16, Tverskaya-Yamskaya ul., 125047, Moscow. Russian Federation

K. A. Poyarkov

Nikiforov National Center for Emergency and Radiation Medicine.

4/2, ul. Akad. Lebedeva, 194044, St. Petersburg. Russian Federation


  1. Postacchini F., Postacchini R. Operative management of lumbar disc herniation: the evolution of knowledge and surgical techniques in the last century. Acta Neurochir Suppl. 2011;108:17-21. doi: 10.1007/978-3-211-99370-5_4.
  2. Patel V.B., Wasserman R., Imani F. Interventional Therapies for chronic low Back pain: a Focused Review (efficacy and Outcomes). Anesth Pain Med. 2015;5(4):e29716. doi: 10.5812/aapm.29716.
  3. Weinstein J.N., Lurie J.D., Tosteson T.D., Tosteson A.N., Blood E.A., Abdu W.A. et al. Surgical versus nonoperative treatment for lumbar disc herniation: four-year results for the Spine patient Outcomes Research Trial (SpORT). Spine (Phila Pa 1976). 2008;33(25):2789-2800. doi: 10.1097/BRS.0b013e31818ed8f4.
  4. Jacobs W.C.H., Van Tulder M., Arts M., Rubinstein S.M., Van Middelkoop M., Ostelo R. et al. Surgery versus conservative management of sciatica due to a lumbar herniated disc: a systematic review. Eur Spine J. 2011;20(4):513-522. doi: 10.1007/s00586-010-1603-7.
  5. Birkenmaier C., Komp M., Leu H.F., Wegener B., Ruetten S. The current state of endoscopic disc surgery: review of controlled studies comparing full-endoscopic procedures for disc herniations to standard procedures. Pain Physician. 2013;16(4):335-344. doi: 10.15674/0030-59872014241-50.
  6. Smith N., Masters J., Jensen C., Khan A., Sprowson A. Systematic review of microendoscopic discectomy for lumbar disc herniation. Eur Spine J. 2013;22(11): 2458-2465. doi: 10.1007/s00586-013-2848-8.
  7. Kreiner D.S., Hwang S.W., Easa J.E., Resnick D.K., Baisden J.L., Bess S. et al. North american Spine Society. an evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J. 2014;14(1):180-191. doi: 10.1016/j.spinee.2013.08.003.
  8. Lindblom K. Diagnostic disc puncture of intervertebral discs in sciatica. Acta Orthop Scandinav. 1948; 17(3-4):231-239.
  9. Feffer H.L. Treatment of low-back and sciatic pain by the injection of hydrocortisone into degenerated intervertebral discs. J Bone Joint Surg Am. 1956;38(suppl a):585-590.
  10. Smith l. enzyme dissolution of the nucleus pulposus in humans. JAMA.1964;187:137-140.
  11. Knezevic N.N., Mandalia S., Raasch J., Knezevic I., Candido K.D. Treatment of chronic low back pain — new approaches on the horizon. J Pain Res. 2017;10: 1111-1123. doi: 10.2147/jpR.S132769.
  12. Giurazza F., Guarnieri G., Murphy K.J., Muto M. Intradiscal O2O3: rationale, injection technique, short- and long-term outcomes for the treatment of low back pain due to disc herniation. Can Assoc Radiol J. 2017;68(2):171-177. doi: 10.1016/j.carj.2016.12.007.
  13. Lu Y., Guzman J.Z., Purmessur D., Iatridis J.C., Hecht A.C., Qureshi S.A., Cho S.K. Nonoperative management of discogenic back pain: a systematic review. Spine (Phila Pa 1976). 2014;39(16):1314-1324. doi: 10.1097/BRS.0000000000000401.
  14. Щедренок В.В., Себелев К.И., Иваненко А.В., Могучая О.В. Результаты пункционных методов лечения остеохондроза позвоночника. Хирургия позвоночника. 2010;(1):46-48. doi: 10.14531/ss2010.1.46-48.
  15. Крутько А.В., Кудратов А.Н., Евсюков А.В. Дископункционное лечение рефлекторно-болевых синдромов шейного остеохондроза методами коблации и химической дерецепии межпозвонковых дисков. Травматология и ортопедия России. 2011;(2):76-81.
  16. Закиров А.А., Древаль О.Н., Чагава Д.А., Рынков И.П., Кузнецов А.В. Лечение спондилоартроза и дискоза поясничного отдела позвоночника комбинированными малоинвазивными методами. Журнал «Вопросы нейрохирургии» им. Н.Н. Бурденко. 2012;(2):17-22.
  17. Михайлов Д.А., Усиков В.Д., Пташников Д.А. Результаты использования механического декомпрессора в лечении дегенеративно-дистрофических заболеваний поясничного отдела позвоночника. Травматология и ортопедия России. 2010;(3):35-40.
  18. Борщенко И.А., Борщенко Я.А., Басков А.В. Алгоритм выбора метода минимально-инвазивного хирургического лечения дегенеративных заболеваний поясничного отдела позвоночника на основе современных методов математического интеллектуального анализа данных. Нейрохирургия. 2013;(2):49-58.
  19. Helm Ii S., Simopoulos T.T., Stojanovic M., Abdi S., El Terany M.A. Effectiveness of thermal annular procedures in treating discogenic low back pain. Pain Physician. 2017;20(6):e447-470.
  20. Анохин М.А., Спирин Н.Н., Иванов А.О. Пункционное электротермическое лечение дискогенных болевых синдромов (IdeT). Российский журнал боли. 2010;3-4(28-29):44-48.
  21. Исайкин А.И., Кузнецов И.В., Иванова М.А., Кавелина А.В. Дискогенные боли в пояснице. современные концепции патогенеза, дифференциальной диагностики и тактики лечения. Эффективная фармакотерапия. 2015;40:6-16.
  22. Manchikanti L., Abdi S., Atluri S., Benyamin R.M., Boswell M.V., Buenaventura R.M., Bryce D.A. et al. an update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. part II: guidance and recommendations. Pain Physician. 2013;16(2 Suppl):S49-283.
  23. Pfirrmann C.W., Dora C., Schmid M.R., Zanetti M., Hodler J., Boos N. MR image-based grading of lumbar nerve root compromise due to disk herniation: reliability study with surgical correlation. Radiology. 2004;230(2):583-588. doi: 10.1148/radiol.2302021289.
  24. Pfirrmann C.W. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine. 2001;26(17):1873-1878. doi: 10.1097/00007632-200109010-00011.
  25. Milette P.C. Reporting lumbar disk abnormalities: at last, consensus! ajNR Am J Neuroradiol. 2001;22(3): 429-430.
  26. Manchikanti L., Falco F.J., Benyamin R.M., Caraway D.L., Deer T.R., Singh V., Hameed H., Hirsch J.A. An update of the systematic assessment of mechanical lumbar disc decompression with nucleoplasty. Pain Physician. 2013;16(2 Suppl):Se25-54.
  27. Cohen S.P., Huang J.H., Brummett C. Facet joint painadvances in patient selection and treatment. Nat Rev Rheumatol. 2013;9(2):101-116. doi: 10.1038/nrrheum.2012.198
  28. Manchikanti L., Benyamin R.M., Singh V., Falco F.J., Hameed H., Derby R. Et Al. An update of thesystematic appraisal of the accuracy and utility of lumbar discography in chronic low back pain. Pain Physician. 2013;16(2 Suppl):Se55-95.
  29. Chen Y.C., Lee S.H., Chen D. Intradiscal pressure study of percutaneous disc decompression with nucleoplasty in human cadavers. Spine (Phila Pa 1976). 2003;28(7): 661-665. doi: 10.1097/01.BRS.0000051920.45671.88.
  30. Singh V., Derby R. Percutaneous lumbar disc decompression. Pain Physician. 2006;9(2):139-146.
  31. Malik K.M., Cohen S.P., Walega D.R., Benzon H.T. Diagnostic criteria and treatment of discogenic pain: a systematic review of recent clinical literature. Spine J. 2013;13(11):1675-1689. doi: 10.1016/j.spinee.2013.06.063.
  32. Peng B.-G. Pathophysiology, diagnosis, and treatment of discogenic low back pain. World J Orthop. 2013;4(2): 42-52. doi: 10.5312/wjo.v4.i2.42.
  33. Shambrook J., Mcnee P., Harris E.C., Kim M., Sampson M., Palmer K.T., Coggon D. Clinical presentation of low back pain and association with risk factors according to findings on magnetic resonance imaging. Pain. 2011;152:1659-1565. doi: 10.1016/j.pain.2011.03.011.
  34. Mcnee P., Shambrook J., Harris E.C., Kim M., Sampson M., Palmer K.T., Coggon D. Predictors of long-term pain and disability in patients with low back pain investigated by magnetic resonance imaging: a longitudinal study. BMC Musculoskelet Disord. 2011;12:234. doi: 10.1186/1471-2474-12-234.
  35. Chou R., Qaseem A., Owens D.K., Shekelle P. Clinical guidelines committee of the american college of physicians. diagnostic imaging for low back pain: advice for high-value health care from the american college of physicians. Ann Intern Med. 2011;154:181-189. doi: 10.7326/0003-4819-154-3-201102010-00008.
  36. Da Rocha I.D., Cristante A.F., Marcon R.M., Oliveira R.P., Letaif O.B., De Barros Filho T.E.P. Controlled medial branch anesthetic block in the diagnosis of chronic lumbar facet joint pain: the value of a threemonth follow-up. Clinics. 2014;69(8):529-534. doi: 10.6061/clinics/2014(08)05.
  37. Van Tilburg C.W., Stronks D.L., Groeneweg J.G., Huygen F.J.P.M. Randomized sham-controlled, doubleblind, multicenter clinical trial on the effect of percutaneous radiofrequency at the ramus communicans for lumbar disc pain. Eur J Pain. 2017;21(3):520-529. doi: 10.1002/ejp.945.

Copyright (c)

СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 82474 от 10.12.2021.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies