The Pain Specialist
3 Mount Elizabeth #15-09
Medical Centre Singapore 228510
In both cases of bulging and herniated disc, the spinal disc puts pressure on a nerve root or the spinal cord and causes back pain or sciatic pain.
Minimally invasive. Maximum performance
Disc Nucleoplasty (and Annuloplasty) is an outpatient, minimally invasive percutaneous approach to disc decompression that is localised and controllable. Disc decompression has been shown to be effective in treating symptomatic patients with back pain associated with contained herniated discs.
With the shrinkage of the gelatinous disc nucleus (and annulus), the bulging disc retracts, the compressed nerve is released, resulting in the pain subsiding.
Disc Tissue Removal with Radiofrequency Energy
Disc Nucleoplasty and Annuloplasty features patented coblation technology, which uses bipolar radiofrequency energy to remove tissue via plasma molecular dissociation.
Coblation uses radiofrequency energy to excite the electrolytes in a conductive medium such as saline solution, creating a precisely focused plasma. The energized particles in the plasma have sufficient energy to break down molecular bonds, excising or dissolving soft tissue, such as the Disc nucleus, at relatively low temperatures (typically 40oC to 70 o C), thereby preserving the integrity of surrounding healthy tissue. The result of coblation is a portion of the nucleus tissue is gently removed, decompressing the herniated disc.
Performed in an outpatient setting, Disc Nucleoplasty uses a needle that emits radio waves to shrink a disc bulge by dissolving excess tissue. This shrinkage of the disc bulge relieves the pressure inside the disc and on the nerves responsible for causing pain. The procedure should take less than one hour.
Over 35,000 patients have been treated to date with no unresolved complications.
How is Disc Nucleoplasty done?
You will be awake during the procedure to provide important feedback to the physician, but you will be under a sedative to diminish your anxiety and any discomfort.
After you are in position on the table, your lower back will be numbed with a local anaesthetic.
Under fluoroscopy(X-ray) guidance, a small, tube-like needle is placed into the centre of the bulged disc.
A small, specialised wand is inserted through the needle, where it is heated to create a series of channels within the disc by dissolving excess tissue.
The wand will then be slowly withdrawn to its original position while thermally sealing the new channel.
You will be closely monitored during your procedure.
The number of channels created is dependent on the disc size. At the end of the procedure, the wand and needle will be removed.
A small bandage will be placed over the needle insertion site, and you will take a short rest until you are ready to go home.
Adult supervision is necessary for the remainder of the day because of sedation effects.
You will receive general activity and rehabilitation guidelines.
You may experience symptoms for 7-10 days until the disc begins to heal.
Prescription medications may be given to relieve these symptoms.
Complications are rare, but we encourage you to keep track of any symptoms you experience after the procedure and report them to your physician at your follow-up visit 7-14 days after the procedure.
A full course of physical therapy will help you to fully recover, strengthen your back and core muscles, and maximise your recovery.
Which works better: Disc Nucleoplasty or Microdiscectomy?
It depends on the nature of the protrusion. A recent study analysed the effectiveness of microdiscectomy on different herniation types found that microdiscectomy performed poorly in patients with contained herniations with no sub-anular fragment, producing high rates of persistent post-operative sciatica, re-herniation and reoperation. The study concluded that” the treatment of anular prolapses with no discrete fragments by means of conventional anulotomy and limited discectomy was unsatisfactory.” These contained disc herniations are ideal candidates for the disc nucleoplasty procedure.
Is Disc Nucleoplasty & Annuloplasty the same as IDET?
No. Disc Nucleoplasty is a percutaneous Disc decompression, using a bipolar radiofrequency coblation plasma device to remove tissue from the nucleus and decompress the disc. A study showing disc decompression with coblation plasma technology was published in the April 2003 issue of Spine””. IDET (Intradiscal Electrothermic (or electrothermal) Therapy) uses conductive heating to treat the anulus of the disc to perform annuloplasty and does not remove tissue. Disc Nucleoplasty treats symptoms arising from contained Disc herniation(bulging). IDET seeks to treat symptoms arising from DISC degeneration (wearing away).