Nucleoplasty is a percutaneus procedure where a catheter is percutaneously inserted into the intervertebral disc under fluoroscopy. The catheter has low-temperature resister probe to disintegrate and evacuate disc material causing disc decompression.
The nucleoplasty is percutaneous and does not require any incision.
Indications for Nucleoplasty
It is most useful in patients with nerve root irritation due to smaller disc bulges or contained ruptures.
The indications include discogenic low-back pain due to disc degeneration, as well as the treatment of lumbar disc bulges or disc ruptures causing radiculopathy.
It is contraindicated in patients with complete disc space collapse leading to inaccessibility of the intervertebral space, active disc space infection, and medical conditions that would preclude its safe performance.
Procedure of Nucleoplasty
Nucleoplasty is usually performed on an outpatient basis. Local anesthesia and mild sedation may be used to reduce discomfort and anxiety.
Under fluoroscopy, a needle is advanced into disc. A specialized catheter is then be introduced through the needle into the disc and positioned where the ablation is desired. The catheter has a low-temperature resister at its tip which generates a plasma field. this plasma field disintegrates disc material into its hydrogen and oxygen constituents which escape through the needle. The tissue ablation and thermal treatment create a series of channels within the disc, reducing the pressure from the contained disc herniation or the nerve root and other pain generating structures.
Results of Nucleoplasty
Because it is relatively new procedure large data is not available on this. While initial results are quite promising in carefully selected patients, large studies need to be carried to know the efficacy. Best results have been obtained in patients with diffuse disc protrusion and radicular pain.
The relief is reported to occur almost immediately after the procedure.
Complications of Nucleoplasty
A relatively safe procedure, no complication has been reported till now.
Nucleoplasty seems to be a very good alternative form of treatment in selected cases of contained disc herniations. Long term results though are awaited.