Nucleoplasty

**liza larence** · July 30th, 2006, 11:03 PM

Seems like there are a few chronic back pain sufferers out there with disc issues that have been offered a "nucleoplasty" as a form of treatment, namely because it is a minimally invasive procedure and has a relatively high success rate. I am in pain management, and we do alot of these with about 80% positive outcomes.
The key thing is....finding the offending part of your anatomy (bad disc or discs) before proceeding. This means you have to go through a hellish diagnostic procedure called a "discogram". Under fluoro, or xray guidance, radio opaque dye is injected into each disc, one at a time...without much in the way of sedation or anaesthesia...to determine the "pain generator" or bad disc. When you get reproduction of your usual radiating pain (though magnified) ...they call it "concordant pain"...( ie:10/10 in severity) and this helps identify the disc that is the root of your problems. Dye injected into an asymptomatic disc doesnt hurt NEARLY as much, if at all...and in the symptomatic disc the dye can also be viewed leaking out of the torn disc into the spinal canal, further confirming the problem rupture. Nucleoplasty would then be performed at a later date after you get through the physical and emotional pain of the discogram (!)
Sorry to alarm, but the discogram IS a necessary part of this process...and some anaesthesiologists will kindly put in a tiny bit of corticosteroid with the dye to decrease post procedure pain and inflammation.
I will describe the nucleoplasty as best I can in my next post on this thread, guys!

**liza larence** · August 13th, 2006, 11:48 AM

The nucleoplasty is an injection procedure...where the needle is inserted into the bulging or torn disc from a posterior approach. The affected disc "or pain generator" is determined during the discogram described above. This needle is then heated with an electric current, and it "cooks" the part of the disc it comes in contact with, rather like cooking an eggwhite... (similar texture change) . The bulging or herniated part of the disc then shrinks back, and the needle also cauterizes the tear where the disc material was oozing out in the first place.
One can expect a couple of weeks of (sometimes intense) achiness at the procedure site due to tissue trauma, but this quickly heals, usually resolving the back and leg pain (sciatica) completely.
The reason for this is simply because the "shrunken" or cooked portion of the disc is out of the way now, and no longer pressing on exiting nerve roots...formerly causing leg pain, pins and needles sensations, and even weakness...now hopefully resolved!
This procedure is primarily to reverse discogenic pain only, and won't help if your back pain is caused by bone spurring of your facet joints (spondylosis) or slippage (subluxation) of one vertebrae over another...called "spondylolisthesis".
Hope that was helpful, pkpk!

**Vizigoth** · August 13th, 2006, 08:14 PM

What about crushed discs that are totally dessicated and collapsed? Does it still work as an effective diagnostic procedure?

**liza larence** · August 13th, 2006, 08:52 PM

Discs that are "collapsed' or dehydrated...crushed or dessicated...all tend to bulge as they lose their elasticity and are squished down by the effects of time, gravity, and heavy axial loading (like squats or military presses) OR no exercise at all. ..you see, paraspinous muscles help keep the disc spaces wide by supporting bony vertebral structure.
Even what appears to be a "degenerated" disc can respond to nucleoplasty after a positive discogram. If one disc is symptomatic, the discogram will painfully remind you exactly which one...and the nucleoplasty at that level can help reduce the pain caused by that degenerated, crushed, collapsed, bulging or slightly torn disc.