Application of Percutaneous Cervical Nucleoplasty Using the Navigable Disc Decompression Device in Patient of Cervical Herniated Intervertebral Disc: A Case Report
A 38-year-old female came to complain of neck pain with radiating to the bilateral upper extremities after a traffic accident at April 26, 2009. The rate of her pain was at 7-8/10 by visual analog scale (VAS) and the pain was aggravated by bending backward and relieved only slightly by resting.\nA physical examination revealed a positive Spurling sign in the bilateral upper extremities. She had no sensory deficits but mild motor weaknesses in the right upper extremity. Deep tendon reflexes are normal and symmetrical. MRI images () demonstrated central disc extrusion at C4-C5, making contact with bilateral C5 nerve roots. The patient was diagnosed with a C4-C5 disc extrusion with bilateral C5 roots impingement. Percutaneous cervical nucleoplasty (PCN) with the navigable disc decompression device (L'DISQ) was performed at C4-C5 disc level with CT and fluoroscopic guidance on June 3, 2009. The procedure was performed using a standard midline approach () []. Procedure time required 3 hours. Her pain was reduced to 5/10 by VAS the first postoperative day. After leaving the hospital, she visited hospital again on June 9, 2009 and did not appeal any pains at that time. However, she admitted again due to aggravation of neck pains radiating to the right upper extremities from January 2010. The rate of her pain was at 6-7/10 by VAS. A physical examination revealed a positive Spurling sign in the right upper extremity. She has no motor deficits but only mild paresthesia on right C4 and C5 dermatomes. The patient was diagnosed with a C4-C5 disc extrusion with right C5 roots impingement. PCN using the L'DISQ was performed again at the same level on March 25, 2010 with fluoroscopic guidance (). Tip of the L-DISQ catheter reached the end of the bulging disc, and disc decompression was done successfully. Her pain was reduced to 5/10 and negative Spurling sign was observed the first postoperative day. After the procedure, posterior neck area axial pain was improved to 4/10 at 2 months and 2/10 by VAS at 6 months later without the pains radiating to the right upper extremity.