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.
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
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.
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
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
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.
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
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.
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?
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.
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
What to Expect From DISC Nucleoplasty
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.
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.
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.