42 Korean J Pain Vol. 24, No. 1, 2011 presence of axial neck pain, unresponsive to 3 months of conservative treatment, MRI evidence of contained hernia- tion, and the disc height more than 75%. Exclusion criteria include that the disc height less than 50%, extruded or se- questrated disc, spinal fracture or tumor, spinal stenosis, complete disruption of the annulus fibrosis, central myel- opathy, instability from degeneration, and extrusion more than 1/3 of the spinal canal. Nardi et al. [1] argued that patient who can be a can- didate for cervical nucleoplasty must have contained her- niation or focal bulging proven on MRI, but Bonaldi et al. [2] reported that the cervical nucleoplasty was performed in the patients who had a bulging, protruding, or soft ex- truded disc which was not sequestrated or migrated de- termined by MRI or CT studies. In our study, we performed cervical nucleoplasty on patients showing extrusion and stenosis in addition to protrusion on their MRI; who had no improvement from more than 3 months of conservative treatment including appropriate pain management; who keenly want non-surgical treatment over surgical treat- ment; and after adequate explanation on the possibility of failure, possible side-effects and costs of nucleoplasty. In MRI studies taken before the procedure, only 17 patients from the total 22 patients had disc protrusion suitable for indications, and from the 5 patients who had non-in- dication, 2 patients showed extrusion while the other 3 pa- tients showed degenerative spinal stenosis. From these patients who had disc extrusion, one expressed ‘excellent’ according to the Modified McNab criteria after the cervical nucleoplasty and the other one was also satisfied and ex- pressed ‘good’. From the 3 patients who had degenerative spinal stenosis, one expressed ‘excellent’ while the other 2 expressed ‘fair’. Considering these results, although more clinical experience should be accumulated, nucleo- plasty could be considered in disc disorders like soft disc extrusions and stenosis prior to surgical treatment if the patient wants non-surgical treatment; however, cautious application of cervical nucleoplasty should be taken after consideration of cost and possible side-effects [5]. In this study, postprocedure MRI studies were acquired in 2 patients who had shown clinical improvement after 2 months follow up. MRI study in one patient showed a mor- phologic evidence of volume reduction of protruded disc material but the other did not. Nardi et al. [1] had reported that regression of the herniated disc shown on the MRI has a correlation with clinical resolution, but Bonaldi et al. [2] reported that clinical improvement did not always ac- company the regression of the herniated disc on MRI. Even in cases where there seems to be no regression of the herniated disc material, a minute reduction in the disc ad- jacent to the nerve root can cause nerve root pressure to fall below the critical point. If the postprocedure MRI had been acquired in all patients, we could have gained more information from the results. However, it was not possible due to the economic circumstances of the patients. Few side effects concerning the cervical nucleoplasty have been reported and no serious side effects have been known. Side effects reported in the study of Bonaldi et al. [2] included 1 case of infectious discitis out of 55 patients, temporary side effects related to local anesthetic (bradycardia, Horner’s syndrome, hoarseness, etc.), and retrosternal and retropharyngeal pain in patients treated on 3 levels but they responded well to conservative treat- ment [11,12]. There was no significant complication related to the procedure within the first month in our study. Nardi et al. [1] and Birnbaum [8] had proven the effi- cacy of nucleoplasty by comparing the cervical nucleo- plasty group and the conservative treatment group. Bonaldi et al. [2] performed cervical nucleoplasty on 55 patients and reported that it was successful in 85% of them. Li et al. [13] reported that 83.73% from the 126 patients treated reported ‘excellent’ or ‘good’ according to the MacNab criteria. In our study, 76% of the patients expressed sat- isfaction by answering ‘good’ or ‘excellent’. These results of cervical nucleoplasty appear to be much better than the results of lumbar nucleoplasty [3,4,7]. However, the rea- sons that the nucleoplasty treatment may be more effec- tive at the cervical level than at the lumbar level are not clear. One possible explanation could be anatomic: The cervical nerve root is confined to a relatively smaller space than its lumbar counterpart so the cervical nerve root re- spond more sensitively to even a minute reduction. For this reason, even if the pressure of the disc is reduced slightly, the decompression on the nerve root and reduction in clin- ical symptoms can be easily obtained. Another reason could be the topography of the lesion and direction from which it is approached for treatment. In lumbar nucleo- plasty, we use a posterolateral approach from the lesion. But in cervical nucleoplasty, we use anterolateral approach to the disc, and so, the SpineWandTM could be accurately positioned in the lesion site posteriorly located. In other words, since symptomatic herniation is directed posterior,