INTRODUCTION Clinically, cervical disc disorders frequently cause cer- vical axial pain, radiculopathy, and myelopathy. This kind of pain from the intervertebral disc is known to be caused by mechanical compression from extruded disc material, accompanying inflammatory response, and released chemical mediators [1]. Generally, for this kind of cervical disc disorder, con- servative treatment such as orthosis, cervical traction, and medication are carried out first. However, if symptoms persist or increase in severity after 6-8 weeks of sufficient conservative treatment, then surgical treatment is con- sidered. Although surgical treatment is relatively well es- tablished and known to be highly successful, it has many drawbacks such as damage to the adjacent tissue (bone, muscle, nerves, and blood vessels), chronic loading to ad- jacent discs which results in damage and transformation, and a long postoperative recovery period [1]. To supplement these drawbacks, MIST (Minimally Invasive Spinal Techniques) have been developed and performed for several years [1,2]. Among these, nucleopasty was developed by Arthro- Care Corporation in the United States, approved by the U.S. Food and Drug Administration in 1999, and first per- formed in July of 2000. At first, Nucleopasty was devel- oped and used to treat contained lumbar disc herniation and protrusion with associated symptoms [1,2]. Sharps and Isaac [3] and Singh et al. [4] reported significant pain re- duction for up to a year after percutaneous disc decom- pression using lumbar nucleoplasty. However, compared to other percutaneous decompression or even lumbar nucleo- plasty, there is a relative lack of research on and clinical experience with cervical nucleoplasty. Cervical nucleo- plasty has only limited evidence (level IV) in the literature concerning the technique like lumbar nucleoplasty, and in- dications are limited to contained herniation and protrusion similar to the lumbar area [1,2,5]. Therefore, the goal of this study is to evaluate on the efficacy, side effects and patient satisfaction with cervical nucleoplasty performed on patients with cervical disc disorders that were un- responsive to conservative treatments. MATERIALS AND METHODS 1. Object of study This study was conducted on 22 patients with cervical SE Sim, et al / Nucleoplasty in Cervical Disc Disorder 37 disc disorders who were treated with cervical nucleoplasty between March 2008 and December 2009 at our hospital. The study was approved by the hospital’s medical research ethics committee, and written informed consent was ob- tained from all patients before the nucleoplasty. Patients were treated with nucleoplasty after con- firmation for the existence of cervical disc disorders re- lated to the patients’ subjective symptoms on the basis of systemic review, physical examination, X-ray studies and magnetic resonance imaging (MRI) examination. Physical examination including neurological examination before the surgery was carried out by the same pain physician. There were no neurological deficits, such as loss of sensory, mo- tor or reflex in any of the patients, but they all complained of just pain. All patients had a simple radiological study and MRI examination done at least once to confirm the ex- istence of cervical disc disorder. The mean time period from onset of symptoms to the nucleoplasty was 25 months, and there had been no improvement despite con- servative pain management including medication, physical therapy, and root blocks. All nucleoplasty was conducted by the same pain physician. 2. Cervical nucleoplasty procedure Before entering the operating theater, 1,000 ml of Hartman’s solution was connected after intravenous can- nulation, and the patient received intravenous injection of 1.0 g of cefazolin as a prophylactic antibiotic 1 hour before the procedure after confirmation of a negative skin test. The patient was placed in supine position on the operation table, and to facilitate access to the cervical disc, a thin surgical roll was placed under the neck so that it was slightly hyperextended. The patient received the vital sign monitoring and oxygen supply at 5 L per minute via nasal prong throughout the procedure. All procedures were per- formed under local anesthesia, but midazolam 2-4 mg was administered for sedation if there was a patient’s demand. Betadine soap and betadine solution were used to disinfect the anterior neck as well as surrounding skin, and steri- lized drapes were applied on the operating area. First, the C-arm was positioned in a lateral view of the surgical field to measure the angle of the target disc (endplate angle). Then, the C-arm was positioned in an antero-posterior (AP) view to confirm the target disc and rotated axially to align the endplate at measured angle in the prior lateral projection. Before the procedure, we