How Well Does the Nucleoplasty Procedure Work for Back Pain?
Most patients with degenerative disc disease get better without needing interventional procedures or surgery. This article discusses the nucleoplasty procedure for degenerative disc disease in patients suffering either from back pain by itself or potentially those with back pain and radiculopathy.
Often times simply watchful waiting will allow the symptoms to improve, at other times physical therapy, chiropractic treatment, and other forms of aerobic exercise may improve disc symptoms.
Undergoing spine surgery for degenerative disc disease is utilized as a last resort in patients whose back and leg pain is intractable to conservative measures. Potential complications of fusion surgery include scar formation, epidural fibrosis, nerve root injury, failure to fuse, hardware failure, failure to relieve pain, infection, or failed back surgery syndrome.
A number of techniques have been used over the past 20 years in the treatment of degenerative disk and also disk herniations as an alternative to open surgical techniques.
These have included chymopapain chemonucleolysis, Intra-discal electrothermal treatment (IDET), and nucleotomy procedures. None of these has achieved unequivocal success however, and some have caused anaphylactic reactions, nerve root injury, or even cauda equina syndrome.
In 2000, the FDA approved the nucleoplasty procedure using coblation technology for percutaneous disc decompression. A piece of the nucleus (inner disc) is taken out and a radiofrequency energy is applied. This provides an excitement to the area’s electrolytes. It breaks down molecular bonds, and some inner disk gets dissolved.
Keeping the radiofrequency energy at relatively low temperatures, the surrounding disc tissue and end-plate cartilage is unaffected. Reducing the pressure in the center of the disc theoretically relieves the chemical and mechanical factors causing pain. How much of the disc is removed with a nucleoplasty procedure? About ten to twenty percent actually.
There have been studies showing new vascularization (bloodflow) can occur post-procedure, and potentially this could lead to regeneration or healing of the disc.
There have not been life threatening complications related to nucleoplasty. There was some soreness after the procedure which tends to resolve nicely and an incidence of numbness, tingling, and potentially some aggravated back pain.
Looking at all research on nucleoplasty, the average success was seen in 62% of patients. A lot of debate exists as to whether or not nucleoplasty works well in those with simply axial low back pain and not a radicular problem. The procedure has shown, however, that it can improve outcomes in individuals suffering from discogenic back pain either with or without a radicular component.
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