NUCLEOPLASTY : SUCCESSFUL TREATMENT OF BACK PAIN

RADIO WAVE INJECTION OFFERS QUICK, LASTING RELIEF - WITHOUT DRUGS

AMANULLAH BASHAR
Dec 17 - 30, 2007

Dr. Aqeel K Khawaja, MBBS, MD (Rheum.), F.C.E.R.A (USA) Rheumatologist & Pain Management Consultant has brought the new method for treatment of spinal cord problems in Pakistan.

Elaborating the details of Nucleoplasty, Dr. Aqeel Khawaja said "If you are one of the many who have been diagnosed with a contained herniated disc (also known as a "thrown-out back" or "pinched nerve" of the leg or arms), the answer may be as familiar as your radio. A promising new procedure called DISC Nucleoplasty uses radio waves - the same energy that sends signals to your car radio - to gently dissolve small amounts of unwanted disc tissue and relieve the pressure that can cause cervical pain radiating to the arms and lower back and upper leg pain".

Nucleoplasty disc decompression falls in the category of "conservative management" much like pain drugs, epidural steroid injections and physical therapy. While this is surgery, he said, I tell my patients that the procedure is more like getting a vaccination or steroid injection than a traditional spine operation. In some cases, Nucleoplasty is the answer to quick, lasting relief - but without the drugs or major surgery associated with other methods.

To understand how a contained herniated disc works, think of a bicycle tire with a bulge in it. The bulge can certainly make for a rough ride. When a bulge or "herniation" appears in the shell of a disc due to injury or the normal aging process, severe pain can result. This is because the disc is surrounded by sensitive nerve roots in the spine. If the bulge is big enough to rub against these nerve roots, pain can radiate throughout the cervical spine and into the arms or lower back and upper legs depending upon the level.

In much the same way that a bulging tire can be corrected by letting out some of the air, a herniated disc can be treated by relieving pressure inside the disc. This is the purpose of Nucleoplasty disc decompression. The procedure begins with a local (or topical) anaesthetic and light sedative. While the patient is awake, small amounts of radio wave energy are released into the damaged disc through a catheter-like device that is about the thickness of a coin. The energy creates a molecular reaction that causes some of the spongy tissue inside the damaged disc to dissolve. As pressure inside the disc is reduced, the herniation in the shell retracts, the irritation to the nearby nerve roots is reduced, and pain is relieved. Typically, the entire Nucleoplasty radio wave injection procedure takes 30 minutes to an hour, and the patient is ready to walk out of the clinic in about 3 hours.

How good is Nucleoplasty's success rate? 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. Based on these studies, approximately 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.

Nucleoplasty radio wave injection has changed the lives of dozens of patients in USA for the better. Over all, more than 5,000 people have been treated with Nucleoplasty to date. The procedure is safe, effective, cleared by the Food and Drug Administration, and recognized by the American Medical Association as a qualified method for treating contained herniated discs. To learn if you are a candidate for DISC Nucleoplasty, Dr. said, I encourage you to discuss this new treatment option with your primary care physician or your spine specialist.

WHAT IS NUCLEOPLASTY? The nucleoplasty device is a catheter that creates a small, highly localized plasma field. This catheter is percutaneously inserted into the intervertebral disc through a stylet. The location is confirmed using fluoroscopy. In nucleoplasty the catheter is activated and gentle movements are made to the catheter as it lies within the disc space. In this way, small amounts of disc material may be ablated within the disc space and disc decompression may be effected.

The nucleoplasty technique is percutaneous and does not require any incision. It is most useful in patients with nerve root irritation due to smaller disc bulges or contained ruptures.

Nucleoplasty is usually performed on an outpatient basis. Local anaesthesia and mild sedation may be used to reduce discomfort during the procedure. Nucleoplasty patients will be awake to provide important feedback to the physician.

With the guidance of x-ray images, the physician first advances a needle into the disc. A specialized device known as a Spine Wand will then be introduced through the needle into the disc. Therapy consists of creating a series of channels in your disc and then thermally treating the tissue immediately adjacent to the wand. The nucleoplasty process usually takes approximately one hour.

(Left) Access needle and Spine Wand in disc; (middle) close-up view; (right) illustration of disc with multiple channels created.

FREQUENTLY ASKED QUESTIONS AND THEIR ANSWERS

Who may benefit from nucleoplasty therapy?

Patients with contained disc herniation may benefit from this therapy. Nucleoplasty is a minimally invasive procedure developed for these patients, combining disc decompression with thermal treatment.

What is a herniated disc?

The disc functions as a shock absorber between the vertebras of the spine. A herniated disc has a defect or weakness in the wall, similar to a "blister" in the sidewall of a tire, which can lead to pressure on sensitive nerve roots and pain receptors in the back.

What does minimally invasive mean?

It means that there is not an incision as in a surgical operation, but is a procedure that is performed through a thin needle percutaneously.

What is percutaneous?

This means through the skin, again as opposed to making a surgical incision.

Who is a candidate for this procedure?

Indications include back pain or combined back and leg pain, which have not improved after approximately three months of conservative therapy, such as rest, pain medication, and physical therapy. Also:

* Positive MRI for contained disc herniation or bulge

* Positive disco gram reproducing patient's symptomatic pain

* Contained disc herniation which measures less than 30% of the diameter of spinal canal)

How does nucleoplasty work?

Nucleoplasty works by utilizing a multifunctional device called a Spine Wand". The wand is passed through a thin introducer needle into the centre of the disc, called the nucleus. When the proper position is confirmed by x-ray techniques, the Spine Wand is used to perform two separate tasks. First, it creates a channel, removing tissue and then it heats and shrinks the tissue through coagulation. This decompresses the disc, reducing the pressure both inside the disc and on nerve roots.

How long does the nucleoplasty procedure take?

Approximately one hour.

Is the nucleoplasty procedure painful?

No. Nucleoplasty is performed under local anaesthesia, with mild intravenous sedation. The procedure itself is virtually painless, and has little to no post-procedure pain.

Is there a long period of disability after the procedure?

No. We recommend standard post-procedure exercise rehabilitation, but it is not mandatory.

Does one need to wear a back support or brace after nucleoplasty?

No. There is no requirement for post procedure bracing.