Some 90 percent of us will experience an aching lower back at some point in our lives. When the pain is chronic, it’s often the result of damaged spinal discs. In the past, the only treatment for severe pain was surgery to fuse the discs. But a new procedure called Nucleoplasty brings the promise of relief without surgery.
Degenerative disc disease is normally the result of aging. At birth, about eighty percent of disc’s nucleus is water. Due to years of wear-and-tear from lifting and other activities, the nucleus has a tendency to lose this water, causing the annulus to bulge, weaken, and sometimes tear. The body will attempt to heal this tear; however, since the disc does not have adequate blood supply, the healing process fails, resulting in pain. In addition, chemicals from the nucleus probably leak through the torn annulus, causing painful inflammation to the nerve roots.
With age or due to injury, cracks or fissures may develop in the wall of the intervertebral disc. Filled with small nerve endings and blood vessels, these fissures are a chronic source of pain in many patients. Additionally, the inner disc tissue (nucleus) will frequently bulge (herniate) into these fissures in the outer region of the disc, likewise stimulating pain sensors within the disc. Nucleoplasty acts exclusively upon the tissues of the disc itself, and should not be expected to relieve symptoms arising from other spinal structures, such as nerve roots or spinal joints. It is therefore very important to diagnose that the disc is the primary source of your back pain. In addition to a clinical examination, Magnetic Resonance Imaging (MRI) or injections of dye into the disc (discography) is used to confirm the diagnosis.
In the Nucleoplasty procedure, Dr. Dominguez removes tissue and applies controlled levels of thermal energy (heat) to the disc. Nucleoplasty is usually performed on an outpatient basis.
Local anesthesia and mild sedation may be used to reduce discomfort during the procedure. You will be awake to enable you to provide important feedback to Dr. Dominguez.
With the guidance of X-ray images, Dr. Dominguez will first advance a needle into the disc. A specialized device, known as a Perc-DTM SpineWand, TM will then be introduced through the needle and into the disc. Nucleoplasty consists of creating a series of channels in your disc and then thermally treating the tissue immediately adjacent to the Perc-D SpineWand. The procedure should take less than an hour.
Who is a candidate for Nucleoplasty?
Nucleoplasty is a minimally invasive procedure developed for patients with contained herniated discs.
Before the procedure
Since you will be receiving medication, it is recommended that you do not eat within four or five hours before the procedure. If you are a diabetic, be sure to discuss your eating and medication schedule with your doctor. You may need to stop taking certain medications several days before the procedure. Please remind Dr. Dominguez of all prescription and over-the-counter medications you take, including herbal and vitamin supplements. He will tell you if and when you need to discontinue the medications.
It is very important to tell Dr. Dominguez if you have asthma, had an allergic reaction (i.e. hives, itchiness, difficulty breathing, any treatment which required hospitalization) to the injected dye for a previous radiology exam (CT scan, angiogram, etc) or if you have had an allergic reaction to shellfish (shrimp, scallops, lobster, crab). He may prescribe some medications for you to take before having the procedure. Tell Dr. Dominguez if you develop a cold, fever, or flu symptoms before your scheduled appointment.
Prior to considering Nucleoplasty decompression, Dr. Dominguez will require a diskogram, as well as facet joint injection, sacroiliac joint injection, and selective nerve block. These specialized pain blocks are done to maximize your success, verifying that the disc is the structure causing your pain.
Rest well the night before the procedure. It is routine for patients undergoing outpatient surgery to be asked not to eat the night before the procedure. Due to the sedative medications given during the procedure, you will probably be asked to arrange to have someone drive you to and from the medical facility.
If you are on Coumadin, Heparin, Plavix or any other blood thinners (including Aspirin), or the diabetic medication Glucophage you must notify this office so the timing of these medications can be explained. You will be at American Pain Institute for approximately 2-3 hours for your procedure. You will need to bring a driver with you.
During the procedure, an IV needle will be placed in your arm, and you will be giving a light sedative. After you are in position on the operating table, your back will be numbed with a local anesthetic. Under x-ray guidance, Dr. Dominguez will place an access needle into your disc. You may experience mild discomfort during this part of the procedure.
The Perc-D SpineWand will then be inserted through the needle and into your disc. Tissue will then be removed as the Wand is advanced into the disc. This creates a small channel. The Wand will then be slowly withdrawn to its original position while thermally sealing the new channel. Throughout the procedure, Dr. Dominguez will monitor your condition and comfort level closely.
Several channels will be created, depending on the amount of tissue to be removed. At the end of the procedure, the Wand and the needle will be removed. A small surgical dressing will be placed over the needle insertion site, and you will rest in a recovery area until you are ready to go home.
The discomfort generated during the Nucleoplasty procedure may take several days to subside, and Dr. Dominguez may prescribe pain medication. During the healing process it is important to treat your back with care. Dr. Dominguez will provide you with activity and physical rehabilitation guidelines. You will be required to do a special physical therapy and rehabilitation program for four weeks after your procedure. You should be able to resume regular activity four hours after your procedure, but due to the sedation given, cannot drive or make legal decisions.
You may experience an increase in your usual pain including muscle soreness in your back where the needles were inserted. Use ice packs three or four times a day and take your usual pain medications. Do not apply heat or soak in water (i.e. tub, pool, jacuzzi, etc.) for the remainder of the day.
What are the risks of Nucleoplasty?
The main risk, though it happens less than 1% of the time, is diskitis, an infection in the disk that can lead to an infection in the spine. You may experience what is called paresthesia. This is a shooting, “electric-shock” type pain that may occur when medicine is injected into the disk and more pressure is put on the nerve. Paresthesia usually passes quickly but on rare occasion, it continues. As with most procedures, there is a small risk of bleeding, infection, nerve injury, or allergic reaction to the medications used. If you experience severe back pain, new numbness, or weakness of your legs, a headache that will not go away or signs of infection in the area of the injection, you should call us right away. There is a rare risk of permanent injury to nerve tissue with weakness or loss of sensation. There is also a rare risk of complication from anesthesia used to make you feel more comfortable during the procedure.