Nucleoplasty is a minimally invasive surgical procedure also commonly called percutaneous discectomy. The technique is used in many patients who have not responded to more conservative therapy options and are frightened by the idea of fully open herniated disc surgery.
This article will detail the percutaneous discectomy procedure and will explain how it might be a good solution for patients with particular varieties of contained disc prolapse. Furthermore, we will compare and contrast this technique against the more popular intradiscal electrothermal therapy (IDET) procedure.
This minimally invasive surgery is very similar to the time tested IDET procedure, but represents a significant improvement over that older surgical technique. This is because it is considered more accurate in the volume of nucleus material which should be treated.
The percutaneous discectomy operation is performed as an outpatient procedure and typically takes about a half hour to complete. The goal here is to decrease interior volume of the disc nucleus, thereby reducing the bulging portion of the intervertebral structure and eliminating any pressure which may have been applied to a spinal nerve or the spinal cord.
During the procedure, the doctor makes a small incision and places a tiny catheter directly into the affected herniated disc. The surgeon then places a small radio transmitter into the disc and treats the nucleus pulposus with specialized radio waves which break up the nucleus material. Just enough nucleus material is destroyed to alleviate the pressure on the outer disc wall, allowing the herniation to shrink and the disc to return to normal asymptomatic size.
After the correct size is achieved, the catheter is removed and the wound is covered. Patients can leave the operating facility immediately and do not usually suffer any significant discomfort from the surgery.
Percutaneous Discectomy Indications
This particular procedure is only indicated for bulging discs, not ruptured discs. It is crucial that the outer disc wall remains intact in order for the technique to be effective. Correct diagnosis of the disc condition is vital and any annular tears must be ruled out if the surgery is going to be considered appropriate treatment.
While the percutaneous discectomy technique can relieve symptoms in some patients, it is still a surgical method of care. Therefore, it should be considered only as a last resort when all other noninvasive modalities have failed. Despite its minimally invasive approach, there are still risks and possible complications which must be discussed, understood and accepted before undergoing treatment.
I am not an advocate of using surgery to correct herniated discs for a number of reasons. Surgery is rarely needed, since most disc pain conditions will resolve themselves. When a disc is blamed for creating chronic back pain, the diagnosis is often incorrect and surgery will have no hope of relieving the pain, unless exclusively due to the placebo effect.
Even when a disc is the actual cause of ongoing pain, nonsurgical spinal decompression is often a far better option and even offers better curative results.
However, all this being said, the percutaneous discectomy technique is generally well tolerated, moderately effective and does not produce significant risk for spinal tissue damage. If you had to choose a particular surgical solution for chronic disc pain, this would be a good contender.