Nucleoplasty is a modern minimally invasive technique used in the surgical treatment of untreated herniated intervertebral discs. The essence of the innovative technology is to insert a puncture needle into the disc, at the end of which a cloud of cold plasma, laser energy or radio frequency waves is generated, due to which part of the nucleus pulposus is destroyed and the so-called “retracting effect” of the pathological displacement into the framework of the normal disc occurs. Thus, equalization of the proportions of fibrocartilaginous formation is achieved, and at the same time the release of the nerve roots from the irritating factor and the long-awaited disappearance of the pain syndrome.
Scheme of the procedure.
There are several types of surgical intervention, technically they are almost identical. However, what distinguishes them from each other is the main biological component of the effect on the gelatinous substance located inside the fibrous ring. In this connection, each of the tactics has its own name:
- cold plasma;
- laser;
- radiofrequency.
Their efficiency rate is about 80%. The operations are low-traumatic, bloodless, easily tolerated and are as safe as possible in terms of the development of postoperative complications. In addition, they are performed under local anesthesia, after which, as a rule, hospitalization of the patient is not required (not always), you can walk after 2 hours, and recovery takes from 2 to 4 weeks.
A set of instrumental needles for the procedure.
All of these advantages naturally increase interest in minimally invasive innovations. And we understand patients perfectly well, because no one wants to endure a more complex scalpel intervention, if today it is possible to eliminate pulpal displacement through a miniature puncture in a matter of minutes, without exposing the body to stress. But here the question is different: is this treatment suitable for you? Our article is dedicated to nucleoplasty and everything connected with it, in which you will find answers to this and other questions that interest you.
Key facts: endoscopic nucleoplasty
- Indications:
Painful protrusion of the intervertebral disc - Strategy:
Through a minimal incision, a small expanding coil is directed to the damaged intervertebral disc, which rotates to remove part of the herniated disc that is putting pressure on the nerve. - Hospital stay:
3 days - Rehabilitation treatment:
14 days outpatient - Recommended time to fly home:
14 days after surgery - Showering:
1 day after surgery - Duration of disability:
1 week - Bibliography:
Endoscopic nucleoplasty using radiofrequency irradiation - Literature
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How effective is endoscopic radiofrequency annulonucleoplasty?
Endoscopic radiofrequency annulonucleoplasty shows excellent clinical results and in practice is more effective than most previously known minimally invasive puncture interventions aimed at treating protrusion and removing spinal hernia. In 90% of cases, this interventional treatment method allows for complete recovery.
Endoscopic radiofrequency annulonucleoplasty is used as the most effective alternative to such interventions as:
What is endoscopic nucleoplasty?
Endoscopic nucleoplasty: interdiscal electrothermal therapy is designed to reduce the volume of intervertebral disc tissue by evaporating part of the liquid core, which helps reduce pressure on the walls of the intervertebral disc, which in turn reduces painful protrusion.
Pain associated with protrusion in the walls of the intervertebral disc subsides after surgery © Viewmedica Endoscopic nucleoplasty is a minimally invasive surgical procedure to reduce the protrusion of a deformed intervertebral disc or reduce a herniated disc.
In both cases, the intervertebral disc puts pressure on the nerve roots or spinal cord, which causes pain in the back and spine.
HISTORICAL BACKGROUND AND SAFETY OF THE METHOD
Cold plasma nucleoplasty has been included in medical practice since 1995, when the American company ArthroCare developed the first cold plasma generator. The term “nucleoplasticity” comes from the Latin “nucleos” - nucleus, and “plasticity” is a reflection of the physical change in the core of the disc under the influence of plasma. The operation received international registration: DISK Nucleoplasty™ by ArthroCare Corp., Sunnyvale, CA USA.
In clinics in the USA, Europe and Israel, nucleoplasty has been used for more than 20 years. During this time, hundreds of thousands of patients were operated on and many clinical studies were conducted, which determined the limits of application of the method.
In 2011, the method was included by the Russian Ministry of Health in the “List of Types of High-Tech Medical Care” with the following description of the goals and technology of the operation: “restoration of the shape and function of the intervertebral disc by puncture decompression nucleoplasty.” This method is officially recognized and approved for use in medical practice in the Russian Federation as a safe and effective method of treating an intervertebral disc in order to restore its shape and function.
At the Re-Clinic Orthopedic Center, nucleoplasty for the treatment of hernias and protrusions began to be used since the opening of the clinic in 2011. At the origins of the application of the method at Re-Clinic was the head of the department of spinal pathology of the Herzliya Medical Center, professor at Tel Aviv University, Ruven Gepshtein (Israel).
Cold plasma has successfully replaced laser, the treatment of which was associated with the risk of overheating of the disc. With nucleoplasty, the temperature of the plasma cloud at the end of the needle is close to body temperature and does not damage the disc, hence the name “cold plasma” method. The absence of adverse events in the long-term period allowed us to recognize the cold plasma treatment method as safe for patients.
When does your neurosurgeon consider performing nucleoplasty?
If there are no positive results after six weeks of conservative treatment, your spine specialist will consider nucleoplasty: a herniated disc can be reduced by reducing the fluid nucleus pulposus using an injection needle. After bringing it to the center of the disk, decompression requires only a few minutes. This catheter needle is very thin and therefore tissue damage is minimal. In this way, complications associated with open spine surgery are avoided. This is essentially the principle of nucleoplasty.
Nucleoplasty is a minimally invasive treatment used only when the outer layer of the intervertebral disc (annulus fibrosus) is not damaged and the protrusion does not exceed a certain size, that is, when treatment with open surgery (surgical removal of disc material) is not possible.
More than 200,000 patients from all over the world have been convinced of the effectiveness of nucleoplasty: in more than 80% of cases the treatment was successful.
Endoscopic nucleoplasty is a minimally invasive procedure that is reliable for patients, provides excellent results, and does not entail postoperative complications encountered in open spinal surgery.
Complications
Any rude and careless actions of a neurosurgeon, non-compliance with intra- and postoperative standards, poor preparation of the patient, lack of proper postoperative rehabilitation - all this can most likely lead to complications. We invite you to familiarize yourself with which ones:
- local infectious process (discitis, purulent focus);
- allergic reaction to anesthesia;
- damage to nervous and vascular formations, nearby internal organs;
- long-lasting hematomas and swelling;
- reflex mediator pain;
- pronounced pain syndrome, manifested by a strong burning sensation when changing posture, during stressful situations and nervous excitability;
- sharp progression of pathology due to burn or mechanical damage to the fibers of the fibrous ring with subsequent rupture.
To be sure that the medical procedure will be successful and will not entail a cascade of unpleasant complications, contact only professional clinical medical-surgical centers that directly specialize in the field of orthopedics and neurosurgery. Cold plasma nucleoplasty, spinal arthroplasty, endoscopic discectomy, microdiscectomy and many other techniques are superbly mastered and perfected in the Czech Republic. The increased demand for treatment of intervertebral hernias in clinics in the Czech Republic is explained by the most reasonable prices with exceptional quality of any procedure and the absence of side effects. At the same time, the treatment program, which is extremely important, always includes rehabilitation. Prices in the Czech Republic are at least 2 times lower than anywhere else abroad.
Terminology
- Nucleoplasty:
Changing the shape or volume of the fluid nucleus pulposus of the intervertebral disc - Coblation:
Short for controlled ablation (removal or reduction of disc material). Coblation is a patented and registered procedure. - Herniated disc:
Damage to the annulus fibrosus around the fluid nucleus pulposus of the intervertebral disc - Intervertebral disc protrusion:
Bulging of the wall of the intervertebral disc - Interdiscal electrothermal therapy (MDETT):
A minimally invasive treatment for discogenic back pain that uses heat to treat the fluid core of the spinal disc.
Nucleoplasty is a minimally invasive method designed to reduce the internal pressure of the intervertebral disc.
High pressure of the fluid nucleus pulposus of the intervertebral disc on the walls can lead to protrusion or herniation, especially if the walls of the intervertebral disc have already been damaged.
Cold plasma coblation of the intervertebral disc is performed in the presence of significant protrusion with protrusion of the fibrous ring, but not in case of a hernia, when the wall of the intervertebral disc is damaged.
As a result of this procedure, a decrease in the volume of the intervertebral disc core is noted, retraction of the convex disc is achieved, the compressed nerve is released, as well as a decrease in pain in the leg and back.
The method is called Interdiscal Electrothermal Therapy (MDETT)
INFORMATION FOR DECISION MAKING
Cold plasma nucleoplasty has been practiced for more than 15 years - it has a well-deserved reputation, transparent statistics and consistently reproducible positive efficiency of 80%. This means that 8 out of 10 people after the procedure forget about the disc, that there was a protrusion or herniation of the disc. And this is a safe method.
At the other, alas, negative pole is the mini-surgery method, “discontinued” by European medicine, but still used in our country. Having a fine line between the therapeutic effect and the development of complications. This is nucleoplasty using a laser . And this is an unsafe method.
Many new and promising treatment methods are coming to Russia from abroad today. With excellent accompanying characteristics. It takes at least 5 years to get a realistic picture of their safety level. Evidence-based, that is, reproducible in different clinics, effectiveness statistics accumulated during this period and a clear understanding of practitioners about the advantages and risks of the new method, only after 5 years from the start of its use will it be possible to answer the question - does this innovation have a future in the arsenal of minimally invasive surgery?
The victorious fanfare that accompanies the “exclusive launch of another untested method on the Russian medical services market” sounds, as a rule, prematurely, ahead of events by the same 5 years... Only after 5 years will the new method be able to leave the area of high risk. And change the “yellow flashing” light to the green light for safe use.
Therefore, we suggest and encourage our readers to be prudent and conservative in choosing a surgical treatment method. To make a decision, you need to have a complete understanding of your diagnosis and all possible medical care options. Trust your health to your doctor if you have an emotional connection with him. The attending physician must be able to explain in simple and understandable language the picture of the disease and the surgical technology. Compare alternative methods, showing their advantages and disadvantages. Together with you, in a direct dialogue, we will find the optimal solution to the medical problem and draw the only correct conclusion. Such a decision will be psychologically conscious and internally accepted for you. And this is very important in such a crucial period of your life, when you are about to have a mini- operation that opens the door to the world of active life.
Advantages:
- A minimally invasive method of endoscopic nucleoplasty: the area around the intervertebral disc is not damaged, the operation is performed using a special injection needle: the muscles, nerves and bones of the person are not affected, there is no surgical scar along the spine.
- According to research results, in more than 70% of cases, the health of patients suffering from chronic back pain improves. With the help of comprehensive diagnostics, good results are achieved.
- Rehabilitation after interdiscal electrothermal therapy (MDETT): no sutures or scars in the spine. The patient can quickly resume professional activities, there are no postoperative complications.
- Nucleoplasty does not have a negative impact on the overall stability and mobility of the spine. The patient does not suffer from side effects.
- Local anesthesia, without the use of general anesthesia. During the operation, the patient is in a semi-conscious state. The whole procedure takes 20-30 minutes.
- The temperature increase is monitored by a specialist and localized. There is no information about intraoperative or postoperative complications. This fact indicates the positive results of radiofrequency nucleoplasty.
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Contraindications to nucleoplasty
- Osteoarthritis of the facet joints
- Isolated acute intervertebral disc injury
- Reduction of intervertebral disc diameter by more than 50%
- Excessive alcohol consumption, heavy smoking
- Spinal instability (spondylolisthesis)
- Severe spinal stenosis
- Violation of the structure of intervertebral discs and severe injuries
- Severe neurological symptoms such as loss of bladder control and sexual dysfunction.
In such cases, please contact our clinic.
Our specialists will help you choose the right treatment method. If you correctly assess the patient's health status, the likelihood of achieving a successful result increases. In this case, patients need a comprehensive examination. Spinal stability is assessed using dynamic x-rays. Intervertebral discs - using MRI examination.
Patients should not have more than one intervertebral disc (one segment) affected at the same time. The pain must be caused solely by intervertebral disc degeneration. The indication for nucleoplasty is unsuccessful conservative treatment of pain for six weeks.
Conservative treatment should always take precedence in the treatment of intervertebral disc and back pain. Diseases such as severe stenosis or degeneration of the facet joint cannot be cured with nucleoplasty.
It will also be necessary to determine the degree of stability of the spinal column. Patients suffering from spondylolisthesis (spinal instability) are not suitable candidates for nucleoplasty.
Intervertebral disc degeneration should not be at an advanced stage. If the intervertebral disc is already destroyed (diameter reduction > 50%), treatment with the MDET method is not performed.
Alternative treatment is also necessary for those patients who have an isolated acute injury to the intervertebral disc.
How is the procedure done?
Before making a final decision on the method of hernia removal, a complete examination of the patient is performed. MRI, CT, radiography, and laboratory tests help to find out about the location of the hernial formation, the condition of the spinal canal and intervertebral discs, and identify contraindications. If necessary, consultations with related specialists are scheduled to clarify the diagnosis.
12 hours before cold plasma nucleoplasty, patients are advised to refrain from eating. This is the only limitation when preparing for surgery. The procedure itself takes place on the operating table. The patient is placed in bed, anesthesia is administered, and the back is treated with antiseptics. Using a needle, the doctor treats the affected area with cold plasma. The movement of the instruments is controlled using x-rays.
The patient's condition improves immediately after the operation (pain goes away), but the full effect of the intervention is assessed after 2-3 months. All this time the patient is observed by a doctor.
Nucleoplasty using electrothermal therapy - step by step
Nucleoplasty of the intervertebral disc
After treating the area in which the operation is performed, our specialists puncture the skin in the area of the affected disc with a special hollow needle. During the operation, our neurosurgeons remove the part of the intervertebral disc substance protruding into the spinal canal without damaging the nucleus pulposus and surrounding tissues. The temperature used is quite low (40°-70°C). After removing the needle, the surgical field is covered with a special bandage; no stitches are required.
What is nucleoplasty?
The fibrous ring of the intervertebral disc strengthens as the temperature of the liquid nucleus pulposus increases. Heat changes the collagen fibers of the annulus fibrosus: the walls of the disc shrink and their thickness increases.
The exact mechanism of the MDET technique has not yet been established, but is considered justified for the reduction of discogenic pain.
Thermal modification of collagen fibers increases the thickness of the annulus fibrosus, which can reduce cracks and other damage. This effect, called disc restructuring, appears 5 months after surgery.
Thermal destruction of the disc's pain receptors, denervation, is also a commonly used treatment strategy that provides immediate pain relief.
Nucleoplasty results
Pain relief from MDET will last for several weeks. Please note that physical therapy is an integral part of the recovery period. After nucleoplasty, the patient’s health improves gradually; full recovery can take up to three months.
Successful results are achieved in more than 80% of cases. A prerequisite for such success is a comprehensive examination and the correct selection of patients. Our neurosurgery specialists must rule out all other possible causes of back pain.
This intervention is minimally invasive and therefore postoperative risks are minimized. There is also no damage to bones, muscles and nerves, which significantly reduces the likelihood of complications, speeds up the recovery process and improves the overall result.
Price for nucleoplasty: costs in Russia, Moscow and abroad
Most hospitals where nucleoplasty is performed are concentrated in Moscow (price in the table) and St. Petersburg. Let's just say that such operations are not common on Russian territory, so finding in any other locality, except for regional and regional centers, and even then not all, a medical institution that has laser, radio frequency vaporization or plasma coblation in its range of services, is very problematic .
But let's get straight to prices, jumping ahead a little, because the issue of cost is no less important for you. And then we will highlight the indications, contraindications, characterize all the remaining methods and list the possible consequences. So, we bring to your attention an overview of approximate prices within the Russian state (St. Petersburg, Moscow) and leading foreign countries.
| Nucleoplasty method | Russia (in rubles) | Czech Republic (in euros) | Israel (in $) | Germany (in euros) | |
| Moscow | Saint Petersburg | ||||
| Cold plasma coblation | from 35000 to 120000 | from 47500 to 110000 | 2500-3000 | 12000-20000 | from 6000 |
| Laser treatment (vaporization) | 42000-55000 | 41300-50000 | up to 3000 | 13000 | 5500-7000 |
| Radiofrequency (RF) destruction | from 22000 | from 20000 | 1500-2000 | 5000 | 5200 |
Rehabilitation
Patients may require one day of bed rest. The patient can return to the usual rhythm of life after 1-6 weeks. However, do not forget that nucleoplasty is only the first step towards a long-term result. The recovery period, including pain relief, is gradual and can last 8-12 weeks.
A comprehensive rehabilitation program will be needed to achieve a more successful treatment outcome. Physical activity should be monitored and increased gradually. Treat the condition of the spine with special attention - this has been necessary at all times and is necessary now. Strengthening the muscles that support the spinal column is especially important.
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Recovery after endoscopic radiofrequency annulonucleoplasty
The postoperative wound (only 7 mm) does not require specific care; it is enough to change the antiseptic bandage once every 2-3 days. The suture is removed 10 days after annulonucleoplasty. Recovery after minimally invasive surgery is comfortable. The patient can return to normal activities the very next day after the intervention, however, we recommend abstaining from non-physical work for 1 week and from physical work for 1 month. Also, after 1 month, the patient comes for a follow-up examination with a neurosurgeon or at least keeps in touch with the attending physician to talk about the progress of recovery and his feelings. To avoid recurrence of a spinal hernia or protrusion, correction of motor habits is necessary. Daily walking of 3-4 km and swimming are recommended (1 month after annulonucleoplasty). Prolonged static load on the spine should be avoided.