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Nucleoplasty

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Introduction

Intervertebral discs are cushion-like structures that are located between the bones that make up the spine.  Under certain conditions, the discs can bulge and cause back pain.  Percutaneous disc nucleoplasty is a minimally invasive procedure used to reduce the pressure inside a disc to relieve pain.  Because no incision is used, the recovery time is shorter and easier than with traditional open surgery methods.

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What is Nucleoplasty?

Nucleoplasty is a minimally invasive procedure for percutaneous disc decompression that uses radiofrequency based technology to ablate and coagulate soft tissue to decompress contained herniated discs. This causes the disc herniation to reabsorb, taking pressure off the exiting spinal nerves.

Why do I need a Nucleoplasty?

This procedure is reserved for patients who have not responded to medications and conservative treatments, such as physical therapy and epidural injections. The nucleoplasty is a type of procedure that can help resolve your symptoms by decompressing your disc herniation, and possibly help avoid surgery.

What is the typical procedure?

Once your provider determines you are a candidate for a nucleoplasty, an appointment will be made for you in an outpatient surgery center. You are generally given an intravenous medication to help you relax for the procedure. You will be watched closely with an EKG monitor, blood pressure cuff and blood oxygen monitoring device. You will not be asleep during the procedure. A local anesthetic will then be injected into the skin in the area that is being examined. A needle is inserted in the skin and into the disc under fluoroscopy (X-ray). A specialized device will then be introduced through the needle and into the disc. The device is then advanced and withdrawn to its original position, creating a series of small channels. The device and needle are then removed and a small dressing is placed at the injection site.

Is this procedure effective?

Yes, the nucleoplasty procedure appears to be reasonable and safe for selected patients with leg and/or back pain, with a 50% to 80% chance for significant ongoing pain relief.

What will I feel during the procedure?

You may feel minimal low back discomfort. During the actual decompression (heating), you may have a very mild reproduction of your usual back and leg pain.

How long does the procedure take?

Treating one disc typically takes 30 minutes, and 2 discs take about 60 minutes.

What are the alternatives to Nucleoplasty?

If you have back and leg (radicular) pain, the alternative treatments are medications, physical therapy, and epidural steroid injections. Your provider is most likely ordering a nucleoplasty because more conservative therapies have failed. You also have the option of surgical intervention.

What are the risks of Nucleoplasty?

As with any procedure, there are some inherent risks, although most of these are minimal. Common risks include but are not limited to bruising, bleeding, headaches, irritation of a nerve or nerve injury, including paralysis, numbness and weakness. Other risks also include infection or reactions to the medications which may cause breathing difficulties and cardiac difficulties which may lead to death. An infection could require the use of antibiotics and/or surgery. Serious risks and complications are extremely rare, however.

Additionally, if the heating element of the catheter comes too close to a nerve root or is placed in the wrong spot, this could cause damage to a portion of the spinal cord. Because of this risk, the procedure is done under fluoroscopic guidance to ensure proper placement prior to and during the procedure. In addition, you are kept awake enough to respond and let us know what you are feeling.

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