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Nucleoplasty For Small, Contained Disc Herniations

Low back pain with leg pain (sciatica) is a common feature with herniated discs. The disc material presses against the spinal nerve causing painful symptoms. The recent trend toward minimizing spinal surgery has led to new techniques. These advances are designed to relieve pressure on the nerve by taking out part (or all) of the disc.

In this study, researchers from Turkey report on the results of percutaneous nucleoplasty (PN) for sciatica caused by disc protrusion. PN uses radiofrequency (RF) energy to destroy the center of the disc called the nucleus pulposus.

This procedure is minimally invasive and only requires a short stay in the clinic or hospital. Patients usually go home the same day. A local anesthetic is used. A RF probe goes in and out of the nucleus creating tunnels or channels in the disc. There is less scarring linked with PN, so fewer cases of pain recurrence.

The results of 52 patients treated with RF nucleoplasty are reported. Thirty-four (34) patients had one disc treated. Eighteen (18) others had two discs treated with this method. Testing done before the PN showed all discs had an intact covering around the disc. This portion of the disc is called the annulus.

Patients were followed for one-year after the procedure. During that time, there were no complications reported. Three-fourths of the patients had complete pain relief at six months. By the end of the year, 84 per cent were symptom-free. Two patients had a second operation within a week of the first procedure due to unrelenting pain.

Although the authors recommend using this treatment method for sciatica caused by contained disc protrusion, an independent researcher questioned the results. Dr. E. J. Carragee from Stanford University School of Medicine pointed out that many patients with sciatica get better without treatment.

Measuring the results after one-year won't sort out who got better with or without treatment. Likewise, a study this small cannot confirm the safety of the procedure. Until further study is done, Dr. Carraggee does not advise using this treatment method just yet.

References: Hasan Mirzai, MD, et al. The Results of Nucleoplasty in Patients with Lumbar Herniated Disc: A Prospective Clinical Study of 52 Consecutive Patients. In The Spine Journal. January/February 2007. Vol. 7. No. 1. Pp. 88-91.

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