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21KF-013
Comparison of the effect of balloon catheter vs nucleoplasty vs balloon catheter and nucleoplasty in patients

JiSung Park, M.D., Na Eun Kim, M.D., Kyung Joo Lee, M.D., Hee Tae Jung, M.D., ByungGun Kim, PhD.

Department of Anesthesiology and Pain Medicine, Inha University Hospital, Inha university School of Medicine, Inhang-ro 27, Jung-gu, Incheon, 22332, Korea

Introduction
Although the prevalence of back pain is about 75%, the response to treatment may vary depending on the cause. If there is adhesion of the lower back or structural deformation according to degeneration, it is difficult to expect the effect of treatment with only drug treatment or epidural block.
Neuroplasty and nucleoplasty are frequently performed in patients with refractory lower back pain, and the purpose of this study was to investigate the effect of each procedure, when the two procedures were combined in patients.
Methods
This study is a retrospective study with 60 patients who enrolled In-ha Hospital Pain Clinic from 2018 to 2020.
Patients who were diagnosed with lumbar spinal stenosis and did not respond to epidural block and drugs, including those who underwent neuroplasty using a balloon catheter and nucleoplasty.
The patients were divided into three groups, and the NRS, ODI, and pain free interval before and after the procedure were investigated. The three groups are: nucleoplasty, neuroplasty using balloon catheter, nucleoplasty and neuroplasty using balloon catheter.
The pain free interval was defined as the time for pain control with an NRS score of 4 or less or only drug treatment.
Results
In the comparison between each group, the pain intensity after nucleoplasty decreased to NRS 3±0.6666, but decreased to 1.778±0.8782 in the group that received nucleoplasty and neuroplasty using balloon catheter, indicating a statistically significant difference (P=0.003).
After the procedure, the ODI decreased to 13.8947±0.8093 in the group that in the nucleoplasty group, and decreased to 11.5000±1.1504 in the group that received both nucleoplasty and neuroplasty using ballon catheter, and there was a statistically significant difference between the two groups (p<0.001).
The patient who underwent nucleoplasty alone showed pain relief for 4.9375±1.2229 months after the procedure, and the group who underwent neuroplasty using balloon catheter showed 5±1.3723 months of pain relief. In the group that received both nucleoplasty and neuroplasty, pain relief was observed for 10.2 ± 1.1142 months.
Discussion
Significant pain reduction and pain relief time can be expected when neuroplasty and nucleoplasty are combined.

References
1. Manchikanti L, Falco FJ, Benyamin RM, Caraway DL, Deer TR, Singh V, et al. An update of the systematic assessment of mechanical lumbar disc decompression with nucleoplasty. Pain Physician. 2013;16(2 Suppl):Se25-54.
2. Masala S, Massari F, Fabiano S, Ursone A, Fiori R, Pastore F, et al. Nucleoplasty in the treatment of lumbar diskogenic back pain: one year follow-up. Cardiovasc Intervent Radiol. 2007;30(3):426-32