Comparison of the Effect of Balloon Catheter vs Nucleoplasty vs Balloon Catheter and Nucleoplasty in Patients With Lumbar Spinal Stenosis

Abstract

BACKGROUND: Nucleoplasty and neuroplasty are often performed in patients with refractory lower back pain when conservative treatment is ineffective. Lumbar spinal stenosis (LSS) is caused by multiple factors; in some cases, a single procedure of nucleoplasty or neuroplasty alone does not provide sufficient treatment effect. OBJECTIVES: This study aimed to investigate and compare the pain relief and pain-free interval among patients with LSS who underwent nucleoplasty, neuroplasty, and combined balloon neuroplasty and nucleoplasty. STUDY DESIGN: Retrospective study. SETTING: In-ha University hospital pain clinic. METHODS: This is a retrospective study of the medical records and survey of 98 patients with LSS who visited a pain clinic between 2019 and 2020 and underwent nucleoplasty, neuroplasty, and combined balloon neuroplasty and nucleoplasty. Patients with disc height < 50% of the adjacent disc on magnetic resonance imaging and those with moderate and severe extraforaminal stenosis were excluded. Thus, 60 patients who underwent nucleoplasty (n = 20), neuroplasty (n = 20), and combined balloon neuroplasty and nucleoplasty (n = 20) for LSS were analyzed. The patients were instructed to rate their pain intensity via an 11-point numeric rating score (NRS) before and after the procedure. The Korean version of the Oswestry Disability Index (ODI) questionnaire was checked before and after the procedure. RESULTS: The pain intensity decreased to NRS 3 +/- 0.14 and 1.85 +/- 0.19 in the nucleoplasty and combined balloon neuroplasty and nucleoplasty groups, respectively, indicating a significant difference (P = 0.003). ODI was significantly decreased after the procedure compared with that before the procedure in all groups. After the procedure, ODI decreased to 13.89 +/- 0.20 and 11.21 +/- 0.33 in the nucleoplasty and combined balloon neuroplasty and nucleoplasty groups, respectively, with a significant difference between the 2 groups (P < 0.05). The patients in the nucleoplasty group achieved pain relief for 4.93 +/- 1.22 months after the procedure, whereas those in the balloon neuroplasty group achieved pain relief for 5 +/- 1.37 months. In the combined balloon neuroplasty and nucleoplasty group, pain relief was maintained for 10.2 +/- 1.11 months (P = 0.003). LIMITATIONS: The pain was assessed with NRS without considering the patients' pain medication. There may be differences in the outcome of the procedure depending on the surgeon. CONCLUSION: The pain reduction effect was greater and was retained for a longer period with combined balloon neuroplasty and nucleoplasty than with nucleoplasty or neuroplasty alone.