Disc Nucleoplasty is a relatively new procedure that is used to treat patients with contained, or mildly herniated discs. This is a decompressive disc procedure where some of the nucleus (nucleus pulposis is the center gel-like substance of the disc) is removed through a probe. No incisions are required to perform this procedure. Typically when a disc herniates, the annulus fibrosis opens and allows the nucleus pulposis to protrude and compress structures such as nerves. A probe 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 usesheat 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. The procedure is performed in an operating room environment with fluoroscopic (x-ray) guidance. Nucleoplasty is done with the patient lying on the stomach. This procedure is done under mild sedation.
Advantages of Disc Nucleoplasty
The Disc Nucleoplasty procedure is a recent and significant leap forward in minimally invasive disc decompression therapy. Disc Nucleoplasty is performed ‘percutaneously’ through a small needle, resulting in minimal trauma and fast recovery times. Because of this, Disc Nucleoplasty disc decompression is performed while the patient is awake, requiring only a topical anesthetic and light sedation. The difference between Disc Nucleoplasty and other methods of percutaneous disc decompression is ArthroCare’s unique Coblation® technology, which enables the surgeon to combine tissue removal with thermal treatment to achieve disc decompression quickly and efficiently. Coblation technology has been used successfully in over 2 million procedures since its introduction in arthroscopic surgery in 1995.
Limitations of Previous Techniques
Previous techniques used for percutaneous disc decompression have suffered from the
Removal of too much tissue – Decompressing the disc in most cases requires the removal of only a small amount of tissue. Excessive tissue removal can cause the disc to lose height, possibly leading to disc degeneration. The DISC Nucleoplasty procedure allows for controlled removal of a precise amount of tissue by the surgeon.
Indiscriminate removal of tissue – removing tissue beyond a small targeted area can cause injury to the annulus of the disc, or to other surrounding structures in the spine. Disc Nucleoplasty provides the surgeon with full control over which tissue is removed.
Thermal injury to the disc – high temperature (>100 deg C) tissue removal systems (including laser) remove tissue by exploding molecules with extreme temperatures, but with the result that remaining tissue can be severely burned or charred. This is particularly of concern in the disc where there are no blood vessels to allow necrotic tissue to be re-absorbed into the body. The Disc Nucleoplasty procedure does not rely on heat for tissue removal, and does not introduce excessive heat to cause such tissue damage in the disc.
Aggressive access into the disc – introduction of large instruments into the nucleus of the disc can cause irreparable damage to the annulus. Such damage has been shown to lead to the onset or acceleration of disc degeneration. The Disc Nucleoplasty procedure uses a small 17 gauge needle to access the disc – no technique uses a narrower needle to decompress the disc.
Unproven technology – use of unproven technology to remove tissue from the disc can be hazardous. Crude mechanical devices or aggressive thermal devices should be thoroughly tested and adequate clinical data assembled before being released for widespread use. Disc Nucleoplasty percutaneous disc decompression relies on proven Coblation technology, used in over two million surgeries to date. Over 20,000 Disc Nucleoplasty procedures have been performed with no unresolved complications documented.
The Disc Nucleoplasty procedure has successfully overcome many of the limitations of previous and currently existing percutaneous disc decompression techniques. Accordingly, it has become a leading method for performing minimally invasive disc decompression, the choice of interventional physicians across the US and around the world. To perform the procedure, a micro-engineered alloy transmitter is introduced into the disc while the patient is awake, requiring only a topical anesthetic and light sedation. Radio wave signals are sent through the transmitter into the jelly-like nucleus of the herniated disc. The radio waves produce a low-temperature ionized gas that breaks up molecular bonds in the spongy nucleus, removing tissue volume.
When the injection procedure is complete, the transmitter is withdrawn. The removal of nucleus tissue relieves pressure on the disc shell, typically allowing the bulge to recede so that the disc no longer irritates the adjacent nerve root.
Normally, the entire procedure takes 20 to 30 minutes, and the patient is ready to walk out of the clinic in about an hour with no hospital stay required. Disc Nucleoplasty percutaneous disc decompression is designed to offer a fast-acting option to drug therapies and steroid injections, on the one hand, and a minimally-invasive alternative to open surgery, on the other.
Clinically Proven Technology
The Disc Nucleoplasty procedure uses an FDA-cleared device, and is a clinically proven treatment with over 20,000 patients treated. The radio wave technology used in Disc Nucleoplasty was developed by ArthroCare, and has been used successfully for years in over two million procedures such as knee and shoulder surgery and tonsillectomy. Using the same proven technology, Disc Nucleoplasty percutaneous disc decompression reduces the volume of the spongy nucleus within the herniated disc. The disc typically returns to a more natural shape, and the source of nerve root irritation is either minimized or eliminated in most cases, allowing the patient to resume their life.