Spinal Surgery News

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Winter 2010
Vertebroplasty & Radiology

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Percutaneous Plasma Disc Decompression For Symptomatic Contained Herniated Discs

Author: Dr Bernd Ferkmann

Introduction
It has been known for years that open surgery in slipped, or contained herniated disks only too often does not keep what it promises. Pain reduction experienced by patients is only short-term, while the percentage of patients requiring further operations remains high1. Many efforts have been made to develop alternative, and less aggressive, treatment approaches in order to provide effective help and relief for those affected.

Provided there are no severe deficits, the first approach in treating a herniated disk will always be conservative treatment. Today, a broad variety of drugs and/or physical exercises are at hand. It is only if these approaches fail should minimally invasive surgery be considered.

Nucleoplasty® Takes The Lead
Today, more and more doctors are using a procedure called Nucleoplasty to treat patients with symptomatic contained herniated discs. The procedure which has been used to treat over 40,000 patients, has met with excellent results whereby over 80 % of patients report significant and sus-tained symptom relief2.

Tissue Vaporized To Gas
The DISC Nucleo-plasty technique is relatively simple. In the lumbar procedure a small 17 gauge needle is inserted into the disc under fluoroscopic control. A SpineWandTM is then inserted through the needle into the disc and a number of “Coblation®” channels are created to remove a small amount of the nucleus pulposis. This removal of tissue decompresses the disc3 and subsequently as the annulus retracts, relieves pressure on the nerve root. The procedure is normally performed under local anesthetic on an out patient basis.

Arthrocare’s patented Coblation technology has already been used in over 3.5 million surgical pro-cedures. Coblation in-volves the formation of a low temperature plasma field which is used to gently dissolve tissue into molecular gas whilst minimizing damage to surrounding tissue. In the case of the Nucleoplasty procedure the gases simply exit through the introducer needle.

No “One-For-All” Treatment
As convincing as the rationale of the Nucleoplasty procedure may be, it is not suited for all patients suffering from a herniated disk. For a reduction in pressure to occur the disc annulus must be intact. Ideally the disc will also have good height >50 % and the protrusion will not obstruct more than 30% of the diameter of the spinal canal.

Summary
Overall Nucleoplasty is a promising and efficacious minimally invasive procedure with a low risk of complication for the treatment of symptoms associated with contained herniated discs. A number of randomised controlled studies are currently underway in order to further delineate the role for this procedure.


Carragee E et al. Clinical outcomes after lumbar discectomy for sciatica: The effects of fragment type and annular competence. The Journal of Bone and Joint Surgery 2003; vol 85-A no 1, pp 102-108. , Sharps L, Isaac C. Percutaneous disc decompression using Nucleoplasty. Pain Physician 2002; vol 5, No 2. pp 121-126. Chen Y et al. Intradical pressure study of percutaneous disc decompression with Nucleoplasty in human cadavers. Stanford School of Medicine, CA. Presented at NASS 2002.

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