PhD defence J.D. (Judith) de Rooij

Summary:

Cervical radicular pain (CRP) due to a disc herniation is a common condition, which, with neurological disorders, can be extremely painful and largely impact one’s daily functioning and quality of life. A wide range of nonsurgical and surgical interventions are used with major impacts on direct and indirect healthcare costs, making it a highly relevant topic. A relatively new minimally invasive approach (i.e., nucleoplasty) is becoming increasingly popular among interventional pain specialists as one of the therapeutic options for the treatment of CRP due to a disc herniation. This thesis focuses on the efficacy and safety of this new treatment option in comparison to conservative and surgical treatments for patients with CRP due to a disc herniation. We have performed several studies, i.e. a systematic review, a RCT and a retrospective cohort study and conclude that when conservative treatment fails and before surgery should be considered, PCN can be a safe and effective treatment for well-selected patients with CRP due to a single-level contained bulging disc herniation. In our view, surgery, i.e. anterior cervical discectomy, will continue to be the standard treatment in cases of osteophytes, myelopathy, or other cases that are not suited to PCN.