Nucleoplasty
Nucleoplasty process is an alternative procedure in meeting the treatment needs of discogenic low-back pain and radiculopathy caused because of disc ruptures. The process involves percutaneous removal of disc material through use of low-temperature resister probe. This allows disintegration and evacuation of disc material which is then followed by thermal treatment of adjacent residual disc material.
The ablating and removal of the tissue in nucleus pulposus of disc is achieved at temperatures of approximately 40-70ºC, thus minimizing the risk of thermal damage to the surrounding tissues.
Indications for Treatment
Certain indications that point towards the need of conducting nucleoplasty procedure include:
· Discogenic low-back pain - Caused because of disc degeneration and treatment of lumbar disc bulges/disc ruptures causing radiculopathy
· Complete disc space collapse - Leading to inaccessibility of intervertebral space
· Active disc space infection treatment
· Other medical conditions that encourage undertaking this procedure
Treatment Technique
Nucleoplasty procedure is performed on outpatient basis, with very little anaesthesia requirement. The process involves percutaneous insertion of cannula positioned in disc space on same side as patient's pain. This is followed by insertion of a catheter under fluoroscopic guidance via needle into disc space and it’s positioning at place where surgeon requires to ablate disc material.
Who Are Candidates for Nucleoplasty?
As per Senior Orthapeadic Surgeon Dr. L. Tomar the patients who should undertake this surgical process are ones who suffer from contained disc herniation and are not responding to conservative care. Some of the typical signs of contained disc herniation are:
· Primary pain radiating down leg/arm accompanied by back pain
Key Procedure Elements
Some of the key procedure elements followed in the surgery includes:
· Procedure performed under guidance of specialists in the field of physiatrist, pain management, interventional radiology and surgeons
· Fluoroscopic guidance employed as introducer needle and placed at nucleus/annulus junction
· SpineWand introduced through passage way into disc nucleus
· Tissue removal by creating channels (lumbar spine) or by spheres (cervical spine)
· Removal of some tissue from center of disc causes reduction in disc pressure, thus easing the symptoms
· After sufficient tissue removal a bandage is placed on skin and patient is discharged home
· Patients usually placed on routine rehabilitation program
Recommended Rehabilitation Protocol -
A rehabilitation protocol is recommended by us that is based on same guidelines as followed in other interventional spine procedures. The rehabilitation procedure incorporates:
· Progressive use of stretching and strengthening exercises
· Staged return to normal daily activities
Benefits -
Some of the derived benefits of Nucleoplasty include:
· Successful decompression of Spinal Disc
· Reducing VAS pain
· Minimally invasive
· Elimination of general anaesthesia requirement
· Elimination of complications resulting from open surgery
· No overnight hospitalization required
· Rapid recovery time
· Patients can go home on the day of treatment
· Quick symptom relief within two weeks for most of the patients
Nucleoplasty process is an alternative procedure in meeting the treatment needs of discogenic low-back pain and radiculopathy caused because of disc ruptures. The process involves percutaneous removal of disc material through use of low-temperature resister probe. This allows disintegration and evacuation of disc material which is then followed by thermal treatment of adjacent residual disc material.
The ablating and removal of the tissue in nucleus pulposus of disc is achieved at temperatures of approximately 40-70ºC, thus minimizing the risk of thermal damage to the surrounding tissues.
Indications for Treatment
Certain indications that point towards the need of conducting nucleoplasty procedure include:
· Discogenic low-back pain - Caused because of disc degeneration and treatment of lumbar disc bulges/disc ruptures causing radiculopathy
· Complete disc space collapse - Leading to inaccessibility of intervertebral space
· Active disc space infection treatment
· Other medical conditions that encourage undertaking this procedure
Treatment Technique
Nucleoplasty procedure is performed on outpatient basis, with very little anaesthesia requirement. The process involves percutaneous insertion of cannula positioned in disc space on same side as patient's pain. This is followed by insertion of a catheter under fluoroscopic guidance via needle into disc space and it’s positioning at place where surgeon requires to ablate disc material.
Who Are Candidates for Nucleoplasty?
As per Senior Orthapeadic Surgeon Dr. L. Tomar the patients who should undertake this surgical process are ones who suffer from contained disc herniation and are not responding to conservative care. Some of the typical signs of contained disc herniation are:
· Primary pain radiating down leg/arm accompanied by back pain
Key Procedure Elements
Some of the key procedure elements followed in the surgery includes:
· Procedure performed under guidance of specialists in the field of physiatrist, pain management, interventional radiology and surgeons
· Fluoroscopic guidance employed as introducer needle and placed at nucleus/annulus junction
· SpineWand introduced through passage way into disc nucleus
· Tissue removal by creating channels (lumbar spine) or by spheres (cervical spine)
· Removal of some tissue from center of disc causes reduction in disc pressure, thus easing the symptoms
· After sufficient tissue removal a bandage is placed on skin and patient is discharged home
· Patients usually placed on routine rehabilitation program
Recommended Rehabilitation Protocol -
A rehabilitation protocol is recommended by us that is based on same guidelines as followed in other interventional spine procedures. The rehabilitation procedure incorporates:
· Progressive use of stretching and strengthening exercises
· Staged return to normal daily activities
Benefits -
Some of the derived benefits of Nucleoplasty include:
· Successful decompression of Spinal Disc
· Reducing VAS pain
· Minimally invasive
· Elimination of general anaesthesia requirement
· Elimination of complications resulting from open surgery
· No overnight hospitalization required
· Rapid recovery time
· Patients can go home on the day of treatment
· Quick symptom relief within two weeks for most of the patients