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Nucleoplasty

What is Nucleoplasty?

Nucleoplasty is a minimally invasive procedure developed to treat patients with contained, or mildly herniated discs. Nucleoplasty literally means removal of the nucleus (nucleus pulposus is the center gel-like substance of the disc.) The outer band-like substance of the disc is the annulus fibrosis. Typically when a disc herniates, the annulus fibrosis opens and allows the nucleus pulposus to protrude and compress structures such as nerves. Nucleoplasty does not involve an incision. A special access needle is placed into the disc under x-ray guidance. A wand-like device is then inserted through the needle and into the disc. The device uses heat to remove disc material and seal the channel made by the needle. Several channels are made depending on how much disc material needs to be removed.


How is Nucleoplasty performed?

The procedure is performed in a surgical center with fluoroscopic (x-ray) guidance. Nucleoplasty is done with the patient lying on the stomach. Intravenous sedation is given to help with comfort and relaxation. The skin is cleaned with an antiseptic solution and the back is numbed with a local anesthetic before the procedure is performed. The patient is monitored with an electrocardiogram, blood pressure cuff and blood oxygen-monitoring device.


What will I feel during the procedure?

You will feel a sense of pressure, or mild discomfort when the needle is inserted into the disc. When an abnormal disc is injected, you will feel pain. Your physician will closely monitor your comfort level during the entire procedure.


How many discs are treated?

Based on your symptoms and your MRI, your doctor will determine which disc(s) may be causing your pain. Typically, only one disc is treated at a time.

How long does Nucleoplasty take?

Nucleoplasty takes about 30 to 45 minutes, depending on the amount of disc material that needs to be removed.


Will the injections hurt?

The procedure involves inserting a needle through skin and deeper tissues, so there is some discomfort involved. However, your doctor will numb the skin and deeper tissues with a local anesthetic using a very thin needle prior to inserting the needle into the disc. Most of the patients receive intravenous sedation and pain medication, which makes the procedure easy to tolerate. You may have a flare-up of your back pain after the injection, but this gets better in a day or two and can usually be managed with ice packs and oral pain medication.
 

 


Will I be "put out" for this procedure?

No. This procedure is done under local anesthesia (novacaine.) Most of the patients also receive intravenous sedation and analgesia, to help them relax and make the procedure easier to tolerate. The amount of sedation given depends upon the patient. You need to be awake enough to tell the doctor what you are feeling.


What should I do after the procedure?

We advise patients to take it easy the day of the procedure. You may need to apply ice to the affected area for 20-30 minutes at a time for the next 48 hours. Your doctor will provide specific activity restrictions if indicated. Typically driving, lifting, bending/twisting at the waist are restricted in the first few weeks. Formal physical therapy may begin at 2 weeks post-procedure.


What are the risks and side effects of nucleoplasty?

Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects, and possibility of complications. The most common side effect is discomfort, which is temporary. Sometimes, the access needle brushes past a nerve root and the nerve root is irritated. This pain gets better quickly. Other risks include infection, bleeding, and worsening of symptoms. Fortunately, because the procedure is performed with x-ray in a controlled environment, serious side effects and complications are rare.

 

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Position of the cannula entering through the annulus. A-Lateral View, B-AP View.

 

 

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Proximal position of the wand protruding from the cannula. A-Lateral View, B-AP View.

 

 

 

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