What Is a Nucleoplasty?
It is a minimally invasive procedure developed to treat patients with contained or small disc herniation, causing persistent leg or arm pain. Nucleoplasty means removal of the nucleus, which is the gel like substance in the center of the disc. The procedure is performed under X-ray guidance, inserting a special needle through the skin and into the nucleus. With a special device (spine wand) a portion of the nucleus is evaporated by a process called ablation and coblation. The end result is a decrease in the size of the herniated disc, relieving the pressure on the nerve or ligaments of the spine. Once the spine wand is removed, the small opening in the disc seals by itself.
Who Is a Candidate for Nucleoplasty?
Nucleoplasty is reserved for patients with mainly persistent leg pain due to a small and contained disc herniations, not responding to conservative therapy such as: medications, chiropractic care, physical therapy and injections.
A contained disc herniation or disc bulge occurs when the wall of the disc (annulus) weakens but does not break open; it still holds the nucleus pulposus. In other words, the gel in the center of the disc is “contained” within the wall of the disc.
These patients do not have significant neurological deficits (leg weakness or inability to control their bowel or bladder functions). It is considered a minimally invasive procedure and performed as an outpatient. Multiple discs can be treated during the same procedure.
Usually the procedure is performed under intravenous sedation with local anesthetic supplementation. Oral medications are also available to assist with relaxation before and during the procedure. You will be taken to the procedure suite, place in the fluoroscopy bed lying on your stomach. Blood pressure and cardiac monitors will be applied. Next, your upper or lower back area will be scrub and cleansed in a sterile fashion. With the aid of an X-ray guidance, which provides constant imaging (called fluoroscopy), the inter- vertebral discs are identified. The physician will then inject a small amount of local anesthetic in the skin and deeper tissues to numb the area. This may be associated with mild and brief stinging sensations. Once the area is numb, your doctor will insert a special needle into the appropriate disc nucleus, under x-ray guidance. A small amount of contrast (X-ray dye) will be injected to confirm proper needle placement. Then, part of the nucleus is removed by a process called coblation-ablation, which heats and evaporates a controlled amount of nucleus. The procedure usually takes about 20 minutes and is associated with minimum post -operative discomfort.
After the Procedure
You will go back to the post anesthesia care unit ( if you received intravenous sedation), where you will be monitored for 30-60 minutes according to your response. Post procedure instructions will be given in a pre-printed form. A follow up appointment will be made for post procedure evaluation in approximately one week. Medications will be given for the post -operative period which will include an antibiotic, a muscle relaxant and an analgesic/anti-inflammatory. The post procedure discomfort is usually minor and can be manage with ice packs and medications.
General Pre and Post Procedure Instructions
If no intravenous sedation is planned, you continue with your usual dietary habits the day of the procedure. If intravenous sedation is planned, avoid eating any king of solid foods prior to the procedure and you may have clear liquids up to 4 hours prior to the procedure. If you are taking Coumadin, Heparin, Plavix or non-steroidal anti-inflamatories (such as aspirin, ketoprofen, naproxen or others), stop taking them at least one week prior to the procedure. If you are diabetic and planning on having IV sedation, our office will give you specific instructions. The decision to return to work after the procedure will be made on an individual basis considering medical necessity and your specific condition.