Percutaneous Nucleoplasty

- a minimally invasive alternative to major surgery for neck and back pain

According to a local survey done in 2000, one in five adults had suffered an episode of neck or back pain in the past six months. A common cause for the pain is the herniated disc in the neck or the lower back.

The disc functions as a shock absorber between the vertebra of the spine. A herniated disc has a defect or weakness in the wall, similar to a "blister" in the sidewall of a tyre, which can lead to pressure on sensitive nerve roots and pain receptors in the back. Spinal nerves are very sensitive to even slight amounts of pressure. Pain, numbness or weakness may occur in one or both legs.

Treatment

Traditionally, open surgery has been used to treat disc herniation. Part of the intervertebral disc will be removed. This provides "decompression" and relieves the pressure of the disc on the adjacent nerve roots. This, however, results in a defect in the shell of the disc and recurrent disc protrusion becomes common.

Disc Nucleoplasty is the latest scientific innovation in performing minimally invasive disc decompression for patients with contained herniated discs. Introduced in 2000, Disc Nucleoplasty uses a unique plasma technology called Coblation to remove tissue from the centre of the disc.

This technique has been available in Singapore for treatment of back pain and sciatica since the last quarter of 2005 but Raffles Hospital is the first and only centre to offer this treatment for patients with neck pain.

How it is done

Under fluoroscopic guidance, a small introducer needle is placed into the centre of the target disc to act as a portal for the wand-like Coblation device. The device uses radiofrequency energy to both vaporise and remove disc material and seal the channel created by each pass of the wand. Like removing fluid from a pressurised balloon, these channels decompress the disc and allow for a retraction of any disc protrusion or herniation that may be irritating nearby nerve roots. As pressure is relieved, pain is reduced.

The Nucleoplasty technique passes through the skin and does not require any incision or surgery. It is useful for patients with nerve root irritation due to smaller disc bulges or contained ruptures.

Nucleoplasty is performed as an outpatient procedure. Local anaesthesia and mild sedation may be used to reduce discomfort during the procedure. The entire procedure takes between 30 to 45 minutes and the patient is ready to walk out within an hour, with no hospital stay required.

To date, more than 35,000 patients have been treated with Nucleoplasty worldwide with very high success rates. Average pain reduction is significant - 55%-60%; and patient satisfaction is high - about 90%.

According to the clinical studies, the results are about equal to those of traditional disc surgeries - but without the trauma, extensive recovery period, high cost or most of the potential complications.

Four out of five Nucleoplasty patients saw successful results as measured by patient satisfaction scores, reduced pain, absence of narcotics use, and return to work.

The procedure is safe, effective, cleared by the Food and Drug Administration, and recognised by the American Medical Association as a qualified method for treating contained herniated discs.

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