***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Purpose To evaluate changes in nucleus pulposus volume as a potential parameter for the effects of disc decompression . Methods Fifty-two discs ( T8 to L1 ) were extracted from 26 pigs and separated into thoracic ( T8 to T11 ) and thoracolumbar discs ( T12 to L1 ) . The discs were imaged using 7.1 Tesla ultrahigh-field magnetic resonance imaging ( MRI ) with acquisition of axial T2-weighted turbo spin-echo sequences for determination of baseline and postinterventional nucleus pulposus volumes . Volumes were calculated using OsiriX ® ( http://www.osirix-viewer.com ) . After r and omization , one group was treated with nucleoplasty , while the placebo group was treated with an identical procedure but without coblation current . The readers analyzing the MR images were blinded to the kind of procedure performed . Baseline and postinterventional volumes were compared between the nucleoplasty and placebo group . Results Average preinterventional nucleus volume was 0.799 ( SD : 0.212 ) ml . Postinterventional volume reduction in the nucleoplasty group was significant at 0.052 ( SD : 0.035 ) ml or 6.30 % ( p<0.0001 ) ( thoracic discs ) and 0.082 ( SD : 0.042 ) ml or 7.25 % ( p = 0.0078 ) ( thoracolumbar discs ) . Nucleoplasty  achieved volume reductions of 0.114 ( SD : 0.054 ) ml or 14.72 % ( thoracic ) and 0.093 ( SD : 0.081 ) ml or 11.61 % ( thoracolumbar ) compared with the placebo group . Conclusions Nucleoplasty significantly reduces thoracic and thoracolumbar nucleus pulposus volumes in porcine discs In this study two strategies in the treatment of Mechanical Spinal Discogenic Pain have been compared : Disc Coablation and Epidural Injection of Steroids . In 2003 50 patients treated with one or two epidural injections have been selected " ad r and om " and 50 patients treated with disc coablation .  Comparison of the data indicated an improvement of average VAS when relaxed for both groups ( p < 0.01 ) , while after slight-moderate strain , this value was significant only after coablation ( p < 0.001 ) . Finally , average VAS was clearly lower ( p < 0.01 ) after coablation as compared to epidural injections Background Cervical disc nucleoplasty is a significant and clinical ly demonstrated innovation in percutaneous disc decompression in case of non-herniated disc protrusions or prolpase . It allows a percutaneous decompression via a 19-gauge needle under utilization of the Coblation ® technique and under C-arm control . Until now the patients suffering of a cervicobrachialgia in cause of a disc prolapse had only the therapeutical solution between conservative treatment and monosegmental spondylodesis or disc prosthesis of the mentioned motion segment . Methods We wanted to demonstrate a new and practicable anatomical pathway for reaching the cervical disc prolapse comparable to the technique for discography of the cervical spine . The introducer needle is advanced into the disc under fluoroscopic guidance using a st and ard anterior – lateral approach . The controller delivers radiofrequency energy to quickly ablate tissue at temperatures between 50 ° and 60 ° C . The decompression will be done in ablation mode by rotating the device through 180 ° for 5 s in the posterior , medial and ventral third of the cervical disc . After failed conservative treatment over an average time period of 3 months we treated 26 patients with a contained herniated prolapse or protrusion with radicular arm pain by percutaneous decompression under utilization of the Coblation ® technique with a controlled energy plasma-mediated field . A r and omized control group of 30 patients was treated alone conservatively with medical and physical therapy in the same period . Results The average preoperative VAS was 8.8 . With a follow-up time of 2-years we found an average pain reduction with the visual pain score ( VAS ) of 2.3 who had a further check-up . The VAS was checked 24 h , 1 week , 3 , 6 , 12 and 24 months postoperatively . No complications with this method were seen . Comparable to the surgically treated group the conservative patients have had a VAS of 8.4 . Under using conservative treatment with physical therapy , physiotherapy , analgetics and perineural injections we have had a diminution of the VAS to 5.1 after 2 years . Conclusion The percutaneous decompression of the cervical disc protrusion with the Perc DC ® —Spine W and by using the Coblation mode is a quick and safe procedure . Furthermore , one may state a persistent pain relief in the follow-up time up to 2 years after the percutaneous decompression of the disc Prospect i ve case series studies have shown that plasma disc decompression ( PDD ) using the COBLATION SpineW and device ( ArthroCare Corporation , Austin , TX ) is effective for decompressing the disc nucleus in symptomatic contained cervical disc herniations . This prospect i ve , r and omized controlled clinical trial was conducted to evaluate the clinical outcomes of percutaneous PDD as compared to conservative care ( CC ) through 1 year . Patients ( n = 115 ) had neck/arm pain > 50 on the visual analog scale ( VAS ) pain scale and had failed at least 30 days of failed CC . Patients were r and omly assigned to receive either PDD ( n = 62 ) or CC ( n = 58 ) . Clinical outcome was determined by VAS pain score , neck disability index ( NDI ) score , and SF-36 health survey , collected at 6 weeks , 3 months , 6 months , and 1 year . The PDD group had significantly lower VAS pain scores at all follow-up time points ( PDD vs. CC : 6 weeks , −46.87 ± 2.71 vs. −15.26 ± 1.97 ; 3 months , −53.16 ± 2.74 vs. −30.45 ± 2.59 ; 6 months , −56.22 ± 2.63 vs. −40.26 ± 2.56 ; 1 year , −65.73 ± 2.24 vs. −36.45 ± 2.86 ; GEE , P < 0.0001 )  . PDD patients also had significant NDI score improvement over baseline when compared to CC patients at the 6 weeks ( PDD vs. CC : −9.15 ± 1.06 vs. −4.61 ± 0.53 , P < 0.0001 ) and 1 year ( PDD vs. CC : −16.70 ± 0.29 vs. −12.40 ± 1.26 , P = 0.005 ) follow-ups . PDD patients showed statistically significant improvement over baseline in SF-36 physical component summary scores when compared to CC patients at 6 weeks and 1 year ( PDD vs. CC : 8.86 + 8.04 vs. 4.24 ± 3.79 , P = 0.0004 ; 17.64 ± 10.37 vs. 10.50 ± 10.6 , P = 0.0003 , respectively ) . In patients who had neck/arm pain due to a contained cervical disc herniation  , PDD was associated with significantly better clinical outcomes than a CC regimen . At 1 year , CC patients appeared to suffer a “ relapse , showing signs of decline in most measurements , whereas PDD patients showed continued stable improvement Conventional open cervical discectomy , with or without bony fusion , in common neurosurgical knowledge is considered the st and ard treatment for cervical disc herniation .  Percutaneous procedures are minimally invasive and offer decreased morbidity , require no bone graft and promise shorter recuperation time . Nevertheless , c and i date s for a percutaneous procedure as inclusion criteria must complain of symptoms related to contained herniated disc or focal protrusion . It does not substitute conventional open procedures required for extruded discs . We used the coblation technology for nucleoplasty of the cervical intervertebral discs . Early and long-term effects and /or complications observed with this procedure have not been reported yet . Fifty consecutive patients presenting with contained herniated cervical disc or focal protrusion causing compression of the cervical roots or cervical pain underwent a nucleoplasty procedure on the pathological disc . A r and omized control group of twenty patients was treated conservatively with medical and physical therapy in the same period and completed the identical follow-up form . In the nucleoplasty group results were complete resolution of symptoms in 80 % of cases , only 10 % referred some residual cervical or radicular pain and are still under follow-up with a wait- and -see prospect i ve . Patients who did not have a clinical resolution were treated with alternative traditional methods ( 10 % ) . Despite the relative low cases number and the limited follow-up the encouraging results induce us to utilize this technique in well-selected cases OBJECT Patients with radiculopathy , with or without back pain , often do not respond to conservative care and may be considered for epidural steroid injection therapy or a disc decompression procedure . Plasma disc decompression ( PDD ) using the Coblation SpineW and device is a percutaneous , minimally invasive interventional procedure . The purpose of this study was to evaluate clinical outcomes with PDD as compared with st and ard care using fluoroscopy-guided transforaminal epidural steroid injection ( TFESI ) over the course of 2 years . METHODS This was a multicenter r and omized controlled clinical study . Ninety patients ( 18 - 66 years old ) who had sciatica ( visual analog scale score > or = 50 ) associated with a single-level lumbar contained disc herniation were enrolled . In all cases , their condition was refractory to initial conservative care and 1 epidural steroid injection had failed . Participants were r and omly assigned to receive either PDD ( 46 patients ) or TFESI ( 44 patients , up to 2 injections ) . RESULTS The patients in the PDD Group had significantly greater reduction in leg pain scores and significantly improved Oswestry Disability Index and 36-Item Short Form Health Survey ( [ SF-36 ] , physical function , bodily pain , social function , and physical components summary ) scores than those in the TFESI Group . During the 2-year follow-up , 25 ( 56 % ) of the patients in the PDD Group and 11 ( 28 % ) of those in the TFESI Group remained free from having a secondary procedure following the study procedure ( log-rank p = 0.02 ) . A significantly higher percentage of patients in the PDD Group showed minimum clinical ly important change in scores for leg and back pain and SF-36 scores that exceeded literature -based minimum clinical ly important changes . Procedure-related adverse events , including injection site pain , increased leg or back pain , weakness , and lightheadedness , were observed in 5 patients in the PDD Group ( 7 events ) and 7 in the TFESI Group ( 14 events ) . CONCLUSIONS In study patients who had radicular pain associated with a contained lumbar disc herniation , those patients treated with PDD had significantly reduced pain and better quality of life scores than those treated using repeated TFESI . In addition , significantly more PDD patients than TFESI patients avoided having to undergo a secondary procedure during the 2-year study follow-up 
    Output:
    
This investigation showed that nucleoplasty constitutes an effective , minimally invasive treatment option for patients with symptomatic contained disc herniations .