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Курсы лечения в Израиле
| Д-р Гад Велан
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What is Cervical Nucleoplasty?
Cervical Nucleoplasty is a minimally invasive surgical technique for decompression of painful cervical (neck) discs.
How does Nucleoplasty work?
Nucleoplasty involves the placement of a loop of shaped wire into the symptomatic disc through a needle. Radiofrequency energy is then used to ablate (surgically destroy) tissue inside the nucleus of the disc. Decompression occurs as the disc contracts. Contraction of the disc results in retraction of the disc bulge or herniation. Decompression of the disc reduces stretching forces that occur with tears of the annulus (rim of the disc). Because the nerves of supplying the disc are only located in the annulus, pain can be reduced by decreasing the stretch of the annulus.
How is cervical nucleoplasty performed?
As mentions above, a needle is placed into the symptomatic disc to accommodate the radiofrequency wire. An intravenous line is placed so that the nurse or anesthesiologist can administer sedative medications. The patient is placed in the supine (lying on the back) position. Strict sterile conditions are used. A right-sided approach is typically used. Local anesthetic injected under the skin with a small needle. A 19 gauge needle (about the size of a medium to small IV needle) is then inserted into the disc under x-ray control. The radiofrequency wire is then placed through the needle and attached to the machine delivering the radiofrequency energy. Test stimulation is then performed prior to radiofrequency lesioning to ensure that there is not conduction of electrical energy to the nerve root. The actual procedure usually takes 30-60 minutes depending on the number of discs treated.
Which patients are candidates for the Nucleoplasty procedure?
The presence of neck pain, neck pain with radiation into the upper extremities, or extremity pain that is likely secondary to the disc source.
Patients should have objective evidence supporting a disc as a potential pain generator. Evidence can include an MRI scan, CT/discogram. Your doctor will determine which studies are necessary before this procedure can be performed.
Patients should have tried conservative therapies. This should have included medical management, physical therapy, spinal injections.
Which patients are NOT candidates for the Nucleoplasty procedure?
Patients that have not tried conservative therapy.
Patients that do not have evidence for pain generator on discography. This may even include patients with morphological abnormalities such as bulging, torn or herniated discs.
Patients with significant neurological deficits in the extremities - loss of sensation or weakness not associated with pain.
Patients with a free disc fragment or a disc that is on the verge of fragmenting off (a significant disc extrusion).
Patients with significant spinal stenosis (narrowing of the spinal canal) from bony compression (such as large, arthritic facet joints)
Patients with a disc that is <75% of normal.
Infection, spinal fractures, tumors.
What is the success rate for Cervical Nucleoplasty?
There have been several outcome studies in literature documenting the beneficial effects of percutaneous lumbar discectomy. average is 85% success rate.
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Д-р Гад Велан
Ортопедия, лечение в Израиле
специалист по ортопедической хирургии
Главный Хирург позвоночника
Медицинский центр "Сорока"
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