CT-Diskography, Diskomanometry and MR Imaging as Predictors of the Outcome of Lumbar Percutaneous Automated Nucleotomy

Abstract

Purpose: This prospective study was performed to assess whether CT-diskography (CT-D), diskomanometry (DMM) including recording of the pain response, or the MR signal intensity of the disks are reliable predictors of the outcome of nucleotomy. Material and Methods: Ninety-one patients, 44 females and 47 males aged 18–68 years (mean 37.4) treated at 99 disk levels were included. All had plain CT, MR imaging, CT-D and DMM performed prior to automated percutaneous nucleotomy with the Nucleotome R system. Results: Sixty-nine (76%) of the patients responded well to treatment within 3 months. Due to recurrences, the success rate at 1 year was reduced to 65%. Except for better results following nucleotomy in patients with similar and identical pain as the presenting complaint provoked at diskography, no association was demonstrated between diskographic parameters, or loss of signal on MR, and the outcome. Better results were also seen in patients with a short history of disk disease, but not in patients with predominantly sciatica and focal hernias compared to those with predominantly low-back pain and diffuse posterior bulges. Conclusion: The results do not justify routine use of diskography prior to nucleotomy in patients with pathologic disks demonstrated by noninvasive methods and localizing sciatic pain.