Economic evaluation of nucleoplasty compared with conventional opened diskectomy in treatment of contained herniated lumbar disk

Abstract

Introduction : Nucleoplasty is a minimally invasive percutaneus lumbar intervertebral disk decompression using coblation energey. The technique is indicated for patients with contained herniated lumbar disk who are unresponsive to conservative management as an alternative treatment. Many recent literatures proved that nucleoplasty is an effective procedure comparable to the standard treatment, but its long-term result is still controversial.

Objective : To compare effectiveness between nucleoplasty and conventional opened diskectomy and to evaluate the economical aspects of nucleoplasty

Setting : Department of Orthopaedics, King Chulalongkorn Memorial Hospital.

Research Design : A non-randomized prospective clinical trial with full economic evaluation

Patients : Contained lumbar intervertebral disk herniation patients with radicular pain who had undergone diskectomy and nucleoplasty at King Chulalongkorn Memorial Hospital from 2004 to 2006

Methods : Thirty-four patients were recruited; twenty into nucleoplasty group and fourteen diskectomy group. Surgical techniques used were based on the patient’s decisions. Pain intensity using 10 cm visual analogue scale and direct medical cost from King Chulalongkorn Memorial Hospital computer data base was collected. The data were analyzed using paired and unpaired student t-test for effectiveness. Costeffective analysis and sensitivity analysis were done to evaluate the economic aspects.

Results : The success rate is 70% in the nucleoplasty group and 86% in the diskectomy group. Both techniques significantly decrease pain compared with the preoperative status. Diskectomy decreases pain more than nucleoplasty in the first month. There is no difference in the overall pain reduction. Cost of nucleoplasty is higher than diskectomy 8,225 bath net and 2,600 per 1 visual analogue scale pain reduction. Regarding sensitivity analysis, however, patients whose income is more than 1,750 baht/day are suitable to choose nuceloplasty.

Conclusions : From the current data we found that for carefully selected contained intervertebral disk patients caused by radicular encroachment who failed conservative treatment, nucleoplasty provided substantial benefit from minimally invasive technique and it is comparable between the conventional opened diskectomy and nucleoplasty in term of effectiveness and economy.