Nucleoplasty, a Minimally Invasive Procedure
for Disc Decompression: A Systematic Review
and Meta-analysis of Published Clinical Studies
Authors: Kirchner Rainer 
Published: February 2021

Background: Nucleoplasty, based on Coblation® technology, is a minimally invasive procedure
used to decompress herniated discs. Reviews to date – exclusively systematic reviews – recommend
nucleoplasty for treating chronic back pain, although with the restriction of limited to fair
evidence. We therefore aimed to summarize and interpret our calculated results, where possible
comprehensively and quantitatively, using statistical methods in the context of a meta-analysis
supplementing a systematic review. In the process, the central question was to statistically determine
whether, and to what extent, nucleoplasty can positively affect pain relief and functional mobility as
well as lower the complication rate.
Objective: Newly published studies made it possible to conduct a meta-analysis of the visual
analog scale (VAS), a measuring instrument used to determine pain intensity, and the Oswestry
Disability Index (ODI), a scale that reflects the degree of impairment in percent. In addition to having
clearly sound evidence for analyzing VAS/NPS data, the present, newly compiled meta-analysis was
able to summarize VAS and ODI data quantitatively and to calculate a total complication rate for the
first time. It was thereby possible to make a first comparison between nucleoplasty and conservative
therapy (including epidural steroid injection).
Study Design: This meta-analysis examined all study data published in clinical trials involving the
nucleoplasty procedure for plasma disc decompression.
Methods: A systematic search using the terms nucleoplasty and/or plasma disc decompression
was conducted for literature listed in MEDLINE. Twenty-seven eligible studies (22 prospective
trials and 5 retrospective trials) were included, and pooled analyses as well as various subgroup
analyses (differentiation between cervical and lumbar disc herniations, comparisons with alternative
treatments such as epidural steroid injection) were performed based on their data.
Results: Pain decreased from a baseline VAS value of 7.27 to 2.12 (postop/first day), 2.50 (one
week), 2.70 (2 weeks), 3.23 (one month), 2.66 (6 weeks), 2.84 (3 months), 3.06 (6 months), 3.03
(12 months), 1.54 (18 months), and 3.69 (24 months) after nucleoplasty. The ODI value (baseline:
58.95) dropped to 28.60 (one week), 29.00 (2 weeks), 23.21 (one month), 30.00 (6 weeks), 18.30
(3 months), 22.54 (6 months), 24.43 (12 months), 12.82 (18 months), and 36.98 (24 months).
Compared to baseline, significant pain reduction and improvement in functional mobility after
nucleoplasty were observed at every time point. Nucleoplasty showed a total complication rate
of 1.5%, with the individual rates being 0.8% for cervical and 1.8% for lumbar nucleoplasty.
Nucleoplasty was superior to conservative therapy at every time point and for all 3 included
parameters, at some measurement time points even significantly.
Conclusions: Nucleoplasty reduces pain in the long term and improves patients’ functional mobility.
It is an effective, low-complication, minimally invasive procedure used to treat disc herniations.
Key words: Nucleoplasty, plasma disc decompression, (contained) herniated discs, visual analog
scale (VAS), numeric pain scale (NPS), complication rate, Oswestry Disability Index (ODI), pain
reduction