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Pain Management

Percutaneous Discectomy - DISC Nucleoplasty Pertaneous Discectomy Treatment

DISC Nucleoplasty Percutaneous Discectomy



Historically, open surgery has been used to treat sciatica, by removing part of the intervertebral disc to provide "decompression" and relieve the pressure of the disc on adjacent nerve roots. Patients requiring decompression surgery are typically those suffering sciatica or leg pain caused by a herniated or 'slipped' disc. Disc decompression surgical techniques have advanced and now the surgery is performed through small incisions and even via endoscopes - all done using a microscope or similar technology to view the surgical access into the disc.

For some patients, however, even more minimally-invasive methods have been made available, whereby the entire decompression is performed percutaneously through a needle. Patients who can benefit from percutaneous disc decompression or "percutaneous discectomy" as it is commonly called, are those with pain arising from a contained herniated disc - that is a bulging disc where there is no rupture in the outer wall.

The use of percutaneous procedures to decompress intervertebral discs dates back to the 1960's. Early procedures showed conclusively that percutaneous disc decompression effectively relieves pain for appropriate patients. Early procedures had limitations, and so over the years a variety of more advanced techniques have been developed.

DISC Nucleoplasty

The most advanced form of percutaneous discectomy developed to date is DISC
Nucleoplasty. Introduced in 2000, DISC Nucleoplasty uses a unique plasma technology called Coblation® to remove tissue from the center of the disc. During the procedure, the DISC Nucleoplasty SpineWand is introduced through a needle and placed into the center of the disc where a series of channels are created to remove tissue from the nucleus. Tissue removal from the nucleus acts to decompress the disc and relieve the pressure exerted by the disc on the nearby nerve root (see Figure 1 and Figure 2). As pressure is relieved, pain is reduced, consistent with the clinical results of earlier percutaneous discectomy procedures.

About Coblation Technology

The Coblation plasma technology used in DISC Nucleoplasty has been used for many years in surgical procedures in arthroscopy and ENT. Coblation has been used in two million other procedures and has become the standard treatment in various arthroscopic applications, and is quickly becoming accepted as a less traumatic method of tonsillectomy in children, offering reduced post-operative pain and faster recovery periods.

The reason that DISC Nucleoplasty is such a significant advance in percutaneous discectomy is its use of Coblation. Coblation has been clinically demonstrated to decompress the disc while preserving healthy tissue. This is because Coblation relies on plasma energy (see Figure 3) rather than heat energy to remove tissue.

As a result, DISC Nucleoplasty provides the therapeutic benefits of earlier percutaneous disc decompression techniques, without many of the unfortunate side effects. There is little tissue trauma, and recovery times are faster than ever before.

Clinical Results of DISC Nucleoplasty

A variety of clinical studies have been used to assess the effectiveness of DISC Nucleoplasty. As mentioned earlier, DISC Nucleoplasty has been shown to be a highly effective procedure in treating leg pain such as sciatica. In addition, it has been shown to be effective in treating certain patients with back pain. Initial outcome studies show very high success rates. Average pain reduction is significant - 55%-60%, and patient satisfaction is high - about 90%. High patient satisfaction has largely been due to (i) the relative ease of the procedure, (ii) the lack of trauma or painful rehabilitation period, (iii) the fact that DISC Nucleoplasty does not diminish the effectiveness of any subsequent procedure such as open surgery, and (iv) in the rare instance that the procedure is not deemed a 'success,' the patient is typically no worse off. There is no downside.

Although long-term data is not yet available, early studies show sustained pain relief out to one-year, with patients remaining steady at their initial post-procedure pain levels. Evidence is mounting that pain relief is sustained through two years post-procedure and beyond.

Who is the right patient?

For appropriately selected patients, DISC Nucleoplasty can relieve back and leg pain symptoms including sciatica and radiculopathy and even purely axial pain caused by a 'central focal protrusion' or central bulge of the disc. DISC Nucleoplasty is a widely accepted treatment for patients with small contained herniations for whom open surgical discectomy offers a poor chance of success. It may also be a promising option for patients with large contained herniations for whom open surgery is not considered an appropriate treatment.

There are some conditions that may mean that DISC Nucleoplasty is not right for you. Your diagnosing physician will know if these apply to you or not.

What to Expect From DISC Nucleoplasty

The DISC Nucleoplasty procedure is very straightforward. A patient receives a local anesthetic and possibly mild sedation - no general anesthetic is required. The needle insertion is simple, with little pain. Once the needle is inserted into the disc, the disc decompression itself takes only a few minutes. The entire procedure lasts about 30 minutes, and the patient is able to leave shortly afterwards, with only a small bandage over the needle insertion site.

The post-op recovery after DISC Nucleoplasty is undemanding. Patients typically feel little pain after the procedure. Patients are required to avoid lifting and strenuous exercise for a period of time, and may go back to sedentary work after only a week or two. Patients with more physically demanding occupations may need to wait longer to recommence work. Some physical therapy may be prescribed.

Conclusion

By overcoming the limitations of prior methods of percutaneous discectomy, DISC Nucleoplasty has demonstrated the potential to produce equivalent, or even better, outcomes in a procedure that is simpler, quicker, and less traumatic and has faster recovery-times. Clinical results are very promising, and patients can generally expect rapid and sustained pain reduction after DISC Nucleoplasty.

   

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Figure 1
Herniated disc compressing nerve root and causing pain.

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Figure 2
Following DISC Nucleoplasty procedure - herniation and pain relieved.

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Figure 3
DISC Nucleoplasty uses Coblation to precisely remove tissue without trauma.

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