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Percutaneous Discectomy
Historically, open surgery has been used to treat sciatica,
by removing part of the intervertebral disc to provide
"decompression" and relieve the pressure of
the disc on adjacent nerve roots. Patients requiring decompression
surgery are typically those suffering sciatica or leg
pain caused by a herniated or 'slipped' disc. Disc decompression
surgical techniques have advanced and now the surgery
is performed through small incisions and even via endoscopes
- all done using a microscope or similar technology to
view the surgical access into the disc.
For some patients, however, even more minimally-invasive
methods have been made available, whereby the entire decompression
is performed percutaneously through a needle. Patients
who can benefit from percutaneous disc decompression or
'percutaneous discectomy' as it is called, are those with
pain arising from a contained herniated disc - that is
a bulging disc where there is no rupture in the outer
wall.
The use of percutaneous procedures to decompress intervertebral
discs dates back to the 1960's. Early procedures showed
conclusively that percutaneous disc decompression effectively
relieves pain for appropriate patients. Early procedures
had limitations, and so over the years a variety of more
advanced techniques have been developed.
DISC Nucleoplasty
The most advanced form of percutaneous discectomy developed
to date is DISC Nucleoplasty. Introduced in 2000, DISC
Nucleoplasty uses a unique plasma technology called Coblation®
to remove tissue from the center of the disc. During the
procedure, the DISC Nucleoplasty SpineWand is introduced
through a needle and placed into the center of the disc
where a series of channels are created to remove tissue
from the nucleus. Tissue removal from the nucleus acts
to decompress the disc and relieve the pressure exerted
by the disc on the nearby nerve root (see Figure 1 and
Figure 2). As pressure is relieved, pain is reduced, consistent
with the clinical results of earlier percutaneous discectomy
procedures.
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Figure 1.
Herniated disc compressing nerve root
and causing pain.
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Figure 2.
Following DISC Nucleoplasty procedure -
herniation and pain relieved.
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About Coblation Technology
The Coblation plasma technology used in DISC Nucleoplasty
has been used for many years in surgical procedures in
arthroscopy and ENT. Coblation has been used in over two
million procedures and has become the standard treatment
in various arthroscopic applications, and is quickly becoming
accepted as a less traumatic method of tonsillectomy in
children, offering reduced post-operative pain and faster
recovery periods.
The reason that DISC Nucleoplasty is such a significant
advance in percutaneous discectomy is its use of Coblation.
Coblation has been clinically demonstrated to decompress
the disc while preserving healthy tissue. This is because
Coblation relies on plasma energy (see Figure 3) rather
than heat energy to remove tissue.
As a result, DISC Nucleoplasty provides the therapeutic
benefits of earlier percutaneous disc decompression techniques,
without many of the unfortunate side effects. There is
little tissue trauma, and recovery times are faster than
ever before.
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Figure 3.
DISC Nucleoplasty uses Coblation to
precisely remove tissue without trauma.
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Clinical Results of DISC Nucleoplasty
A variety of clinical studies have been used to assess
the effectiveness of DISC Nucleoplasty. As mentioned earlier,
DISC Nucleoplasty has been shown to be a highly effective
procedure in treating leg pain such as sciatica. In addition,
it has been shown to be effective in treating certain
patients with back pain. Initial outcome studies show
very high success rates. Average pain reduction is significant
- 55%-60%, and patient satisfaction is high - about 90%.
High patient satisfaction has largely been due to (i)
the relative ease of the procedure, (ii) the lack of trauma
or painful rehabilitation period, (iii) the fact that
DISC Nucleoplasty does not diminish the effectiveness
of any subsequent procedure - such as open surgery, and
(iv) in the rare instance that the procedure is not deemed
a 'success', the patient is typically no worse off…
there is no downside.
Although long-term data is not yet available, the early
studies show sustained pain relief out to one-year, with
patients remaining steady at their initial post-procedure
pain levels. Evidence is mounting that pain relief is
sustained through two years post-procedure and beyond.
Who is the right patient?
For appropriately selected patients, DISC Nucleoplasty
can relieve back and leg pain symptoms including sciatica
and radiculopathy and even purely axial pain caused by
a 'central focal protrusion' or central bulge of the disc.
DISC Nucleoplasty is a widely accepted treatment for patients
with small contained herniations for whom open surgical
discectomy offers a poor chance of success. It may also
be a promising option for patients with large contained
herniations for whom open surgery is not considered an
appropriate treatment.
What to Expect From DISC Nucleoplasty
The DISC Nucleoplasty procedure is very straightforward.
A patient receives a local anesthetic and possibly mild
sedation - no general anesthetic is required. The needle
insertion is simple, with little pain. Once the needle
is inserted into the disc, the disc decompression itself
takes only a few minutes. The entire procedure lasts about
30 minutes, and the patient is able to leave shortly afterwards,
with only a small bandage over the needle insertion site.
The post-op recovery after DISC Nucleoplasty is undemanding.
Patients typically feel little pain after the procedure.
Patients are required to avoid lifting and strenuous exercise
for a period of time, and may go back to sedentary work
after only a week or two. Patients with more physically
demanding occupations may need to wait longer to recommence
work. Some physical therapy may be prescribed.
Conclusion
By overcoming the limitations of prior methods of percutaneous
discectomy, DISC Nucleoplasty has demonstrated the potential
to produce equivalent, or even better, outcomes in a procedure
that is simpler, quicker, and less traumatic and has faster
recovery-times. Clinical results are very promising, and
patients can generally expect rapid and sustained pain
reduction after DISC Nucleoplasty. |
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