OrthoNeuroSpine & Pain Institute
Nucleoplasty is the most advanced form of percutaneous discectomy developed to date. Nucleoplasty uses a unique technology to remove tissue from the center of the disc. Tissue removal from the nucleus acts to “decompress” the disc and relieve the pressure exerted by the disc on the nearby nerve root . As pressure is relieved the pain is reduced.
Nucleoplasty has been shown to be a highly effective procedure in treating leg pain such as sciatica, as well as back pain with radiculopathy. Average pain reduction has been reported as significant - and patient satisfaction has been high. High patient satisfaction has largely been due to the ease of the procedure, the lack of trauma or painful rehabilitation period, the fact that nucleoplasty does not diminish the effectiveness of any subsequent procedure - such as surgery, and in the rare instance that the procedure is not deemed a 'success', the patient is typically no worse off… there is no downside.
Nucleoplasty is a widely accepted treatment for patients with small contained herniations for whom open surgical discectomy offers a poor chance of success. It may also be a promising option for patients with large contained herniations for whom open surgery is not considered an appropriate treatment.
What is nucleoplasty?
Nucleoplasty is a minimally invasive procedure designed to treat back pain or leg pain caused by contained disc herniations. It works by decompressing the nucleus of the disc. Similar to letting air out of a tire, removing tissue from the center of a disc causes a reduction of pressure within the disc. This in turn leads to a reduction in the pressure that the disc applies to other parts of the body, such as nerve roots or the spinal cord.
What type of symptoms can be treated?
The procedure treats those who suffer from a contained disc herniation that has not responded to conservative care. Typical signs of a contained disc herniation are pain radiating down the leg or arm accompanied by some back or neck pain. Nucleoplasty is not useful for degenerative disc disease or spinal fractures.
What happens before the procedure?
Medical evaluation includes a physical exam. Diagnostic tests such as MRI (magnetic resonance imaging), steroid injection or discography may be conducted to diagnose and locate the symptomatic disc herniation and determine if the procedure is appropriate.
How does the procedure work?
Nucleoplasty requires the patient to lie on his/her stomach for the lumbar procedure or back for the cervical procedure. The procedure is performed under X-ray guidance to accurately place a needle into the disc. Sedation may be administered by your doctor. A small nick is made in the skin near the spine, and a needle is inserted. The decompression device, called a SpineWand, is then inserted through the needle into the disc and activated to remove tissue. The device and the needle are removed and the small nick is covered with a bandage.
Will the procedure hurt?
Because Nucleoplasty is a minimally invasive procedure performed under local anaesthesia, there should be minimal pain. A patient may experience some discomfort or bruising where the needle was inserted.
What happens after the procedure?
Patients are required to remain for observation for one to two hours after the procedure. Often patients are then released to rest for one to three days with limited sitting or walking.
How long does the procedure take?
The total procedure time is generally between 15 minutes to 1 hour.
Can my symptoms be relieved?
In most cases, symptoms caused by the herniated disc are gone or diminished within weeks.
Q: What is Nucleoplasty?
A: Nucleoplasty is a procedure name used to describe a disc decompression performed using Coblation® technology to ablate and remove tissue in the nucleus pulposus of the disc. Because tissue removal is achieved at temperatures of approximately 40-70ºC, thermal damage to surrounding tissue is minimized. Coblation technology has been used in over 4.5 million procedures worldwide.
Q: Are the products and technology used in this procedure FDA cleared?
A: Yes. The SpineWandsTM, including the DLR, DLG, and DC SpineWands have a FDA 510(k) clearance for "ablation, coagulation, and decompression of disc material to treat symptomatic patients with contained herniated discs." The devices are also CE Marked
Q: What are the key elements of the procedure?
A: Nucleoplasty is performed on an outpatient basis, with minimal anesthesia requirements. Fluoroscopic guidance is employed as an introducer needle is placed at the nucleus/annulus junction. A SpineWand is introduced through the passage way, and advanced into the disc nucleus. Using Coblation, tissue is then removed by either creating channels (lumbar spine) or spheres (cervical spine). After sufficient tissue is removed, a bandage is placed on the skin and the patient is discharged home. Patients are then usually placed on a routine rehabilitation program.
Q: Do you need to aspirate the by-products from ablation?
A: No. The low molecular weight gases produced by ablation pass out of the disc via the introducer needle. Cadaver and animal studies, along with extensive clinical experience, confirm that aspiration is unnecessary.
Q: Can you do the procedure immediately after a discogram?
A: Yes. Use the 17 gauge Crawford needle for access (when performing the discogram), and the needle can remain in place in the annulus for the Nucleoplasty procedure. For improved imaging of the DLR Wand, physicians have suggested a 50% dilution of the contrast used during the discogram.
Q: Should a physician administer antibiotics during the procedure?
A:Use of antibiotics is not required. However many physicians will administer antibiotics anytime the annulus is penetrated – due to the increased risk of infection leading to discitis (inflammation of the disc). They generally use the same dose as following a discogram.
Q: Does a Nucleoplasty patient need to wear a brace after the procedure?
A: A brace is not required, since the annulus has not been compromised by the procedure. However, a number of Nucleoplasty centers are using a soft brace for two reasons:
The brace reminds the patient that they have had a minimally invasive procedure, and they should allow their back to heal (as they progressively return to normal activities).
The brace requires the patient to maintain good posture for their lower spine – as part of an overall program of post-procedure rehabilitation (to teach the patient good habits for spine posture and conditioning). A Rehabilitation protocol is intended to support an optimal outcome from the Nucleoplasty procedure, while helping the patient to avoid re-injury.
Q: Is a Rehabilitation Protocol recommended following the procedure?
A: A rehabilitation protocol is recommended, but not necessarily required for Nucleoplasty. Most centers have utilized the same rehabilitation guidelines as they utilize for other interventional spine procedures. An appropriate rehabilitation procedure should incorporate progressive use of stretching and strengthening exercises, followed by staged return to more normal activities.