Nucleoplasty (Percutaneous Disc Decompression)

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 The device is then advanced and withdrawn to its original position, creating a series of small channels.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.

The Arthrocare® Spine Website includes additional information and video.

 

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Dear Dr Komar, I wanted to express my heartfelt appreciation for your help in achieving one of my lifetime goals, completing an Ironman Triathlon.  Without your help, I would not have been able to even participate in the event, no less complete this challenge. A little background:  Late last year, I began training for a “bucket-list” physical challenge that I had long dreamed of completing, a 140.6 mile Ironman Triathlon.  About 3 months into that training, my goal to complete this event appeared nearly impossible.  I had developed tendonitis in my right hip and physical therapy simply wasn’t relieving the pain.  The thought of biking 112 miles and running 26.2 miles with that level of pain was unthinkable.  Just as I began to fear that I’d be forced to give-up, Helen Basey, (a friend whom I truly respect and admire and just so happens to be your marketing coordinator), told me about your successes with the PRP procedure.  Admittedly, I was quite skeptical. Physical therapy had been ineffective in addressing my pain, so how could a quick procedure and mere 2 week recovery period solve a condition that had turned into chronic pain?   You took the time to provide a detailed explanation of my tendonitis and how the PRP procedure works; you showed enormous patience in outlining the recovery process; you resolved my skepticism!  So, 10 weeks prior to the triathlon event I scheduled the procedure.  The results were even better than I had hoped.  A fairly painless procedure, two weeks of recovery time, and I was back to running, biking, and swimming, with no pain.  At this point, I consider you and your staff miracle workers!  I know that medical outcomes can be measured in many different ways.  My measurement was simple – 140.6 mile Ironman Louisville completed in 14:45 (time) without the hip pain that had so impacted my daily life.  Priceless!  Dr Komar, I am eternally grateful for what you did in helping me achieve my dream.  The day I scheduled my initial consult at Southwest Spine and Sports I became a patient; today, I consider myself a true believer and friend.  Thank You! ~Kelli M
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Did You Know?

Most musculoskeletal injuries can be successfully treated nonsurgically.