Percutaneous Disc Nucleoplasty for Lumbar Herniated Discs

Percutaneous disc nucleoplasty is used to treat lumbar herniated discs and painful spinal disc protrusion. This treatment involves a 2-day hospital stay, and around 14 days of outpatient rehabilitation. The procedure is designed to reduce the tissue volume of the spinal disc by evaporating some of the liquid core (nucleus), which lowers pressure along the disc walls (annulus layers).

What is the purpose of the percutaneous disc nucleoplasty?

The percutaneous disc nucleoplasty is a minimally invasive procedure to reduce the contents of a bulging or herniated disc. The protrusion of the disc puts pressure on a nerve root or the spinal cord, and this can lead to persistent back pain and radiculopathy (shooting pain down an extremity with associated weakness and numbness).

When will the neurosurgeon or Colorado pain doctor consider nucleoplasty?

If you are experiencing back pain and radiculopathy related to a herniated or bulging disc, the doctor will first attempt conservative treatment. This involves medications, physical therapy, and topical treatments. If these therapies are not successful, the spine specialist may consider the percutaneous disc nucleoplasty.

How is the percutaneous disc nucleoplasty performed?

After you arrive at the procedure center, you change into a procedure gown. A nurse reviews the risks and benefits of the procedure and has you sign a consent form. A catheter is placed in your arm so IV sedation can be administered. During the procedure, the disc protrusion is reduced by treating the liquid core using an injection needle. The needle and cannula is inserted into the disc using real-time x-ray. Once position is verified, the doctor uses radiofrequency energy to evaporate the inner core. The doctor removes the needle and applies a bandage to the injection site.

What are the advantages of the percutaneous disc nucleoplasty?

The procedure has a success rate of around 80% for treating the pain associated with a herniated disc. With this minimally invasive approach, the area around the disc is not damaged or traumatized by open surgery. All surgical manipulation takes place through the cannula, so no muscles, bones, or nerves are disturbed. Another advantage of this procedure is that sedation is used, so the patient does not have to undergo general anesthesia.

Who is a candidate for nucleoplasty?

Not all patients will benefit from the percutaneous disc nucleoplasty. Those who should not have the procedure are people with:

  • Sequestered disc herniation
  • Pain from facet joint arthritis
  • A loss of disc diameter by more than 50%
  • Severe spinal stenosis
  • Disrupted disc morphology
  • High grade disc injury
  • Unstable vertebrae or spondylolisthesis
  • A high alcohol intake
  • Long history of smoking
  • Numerous herniated discs
  • Advanced disc degeneration

How does percutaneous disc nucleoplasty work?

The fibrous ring of the intervertebral disc is strengthened by heating the inner core liquid. The heat modifies the collagen fibers of the outer disc layers. The disc wall contracts and increases in thickness, which repairs degeneration and cracks (disc restructuring).

What is rehabilitation like after the nucleoplasty procedure?

After the procedure, recovery is gradual, and takes around 8-12 weeks. The patient will work with a physical therapist to regain flexibility and strength of the back. In addition, the therapist uses massage and electrical stimulation to relieve pain.

Does percutaneous disc nucleoplasty work?

In a recent study, researchers evaluated the effectiveness of nucleoplasty for decompression of a herniated disc. The researchers used the visual analog scale, absence of narcotic use, patient satisfaction reports, and return to work as efficacy measures. Patients were assessed at 1-, 6-, and 12-months post-procedure. Overall, patients had an 82% success rate, which indicated that nucleoplasty was an effective procedure for treating the symptoms of herniated disc.

Resources

Sharps LS & Isaac Z (2002). Percutaneous disc decompression using nucleoplasty. Pain Physician, 5(2), 121-126.