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.
Numerous techniques have been utilized over the past few decades to treat degenerative disc disease along with disc herniations outside of open operating room 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.
Nucleoplasty of the disc was approved in 2000 by the FDA as a percutaneous disc decompression using coblation technology. A piece of the inner disc (the nucleus) is removed and a radio frequency energy is applied which excites the electrolytes in this area. Molecular bonds are broken down, and some of this inner disc is dissolved.
As long as the radio frequency energy stays at relatively low temperatures, the theory is that 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 1 milliliter, which is about 10 to 20%.
There have been studies showing new vascularization (bloodflow) can occur post-procedure, and potentially this could lead to regeneration or healing of the disc.
Most studies have shown no significant complications related to nucleoplasty. There was soreness post procedure which resolved nicely and an incidence of numbness and tingling and potentially worse back pain.
Looking at all studies on nucleoplasty, the average successful outcome was 62%. There is considerable debate as to whether or not nucleoplasty works well in patients with solely axial low back pain and not a radicular component. 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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