PERCUTANEOUS LUMBAR NUCLEOTOMY

WHAT IS A HERNIATED DISC?

Herniated lumbar disc

A herniated disc is the result of a degenerated intervertebral disc, which protrudes out of its normal space. Intervertebral discs are fibrous structures that act as pillows between each two vertebrae, cushioning the movements of the spine. Several diseases, trauma or even age can cause these discs to lose their elasticity, thus becoming more susceptible to fragmentation. When all or part of an affected lumbar disc slides out of its normal location, nerve roots may be compressed, causing pain.

Herniated lumbar disc

 

ARE THERE DIFFERENT TYPES OF HERNIATED DISC?


Intervertebral discs are made up of the nucleus pulposus, the soft tissue of the disc, and the annulus, the outer layer which completely surrounds this soft tissue in order to support and protect it. Depending on how these parts degenerate, there can be 2 types of herniated disc:

  • In contained herniated discs the nucleus pulposus pushes the annulus, causing a bulge that compresses nervous tissue. These cases may benefit from a percutaneous nucleotomy.

  • In non-contained herniated discs the nucleus pulposus goes through the annulus and compresses the nervous tissue. These cases are not good candidates for a nucleotomy.
Contained herniated lumbar disc
Non-contained herniated lumbar disc
Contained herniated lumbar disc

Non-contained herniated lumbar disc

WHAT WILL HAPPEN DURING A PERCUTANEOUS LUMBAR NUCLEOTOMY?

Percutaneous lumbar nucleotomy

Nucleotomy is in fact a quite old procedure that is only recommended for a small subgroup of patients. However, performing it using minimally invasive techniques has made nucleotomy available for older patients and patients with poor general condition.

The aim of percutaneous lumbar nucleotomy is to reduce the prolapsed part of the nucleus pulposus enough so that the pressure on the nerve root is released. A large-bore needle connected to a trephine and a suction device is inserted into the disc and used to remove a portion of the nucleus pulposus, releasing the pressure off the nerve root and so relieving the pain.
Usually, percutaneous nucleotomy is performed on an outpatient basis, which means that the patient returns home after completion of the procedure. It will probably be carried out under local anaesthesia and sedation.

Percutaneous lumbar nucleotomy
 

If you are conscious during the procedure, you may feel discomfort. The level of discomfort is different for every person and so it is impossible to predict how much you will feel. However, if you feel any discomfort you can tell the doctor and the anaesthesia will be adjusted accordingly.

The scar left will actually only be a few millimetres long, and a plaster will be placed over it to make sure it heals properly. Usually, the patient’s quality of life will improve over the few days following surgery, a considerable relief of pain being already felt on the day of the procedure. If necessary, however, additional therapy will be recommended.

AM I SUSCEPTIBLE TO TREATMENT WITH A NUCLEOTOMY?

Your case must be evaluated thoroughly to assess if a nucleotomy can restore the quality of life you had before the start of the leg and low back pain.


WHAT ARE THE RISKS?

All surgical procedures have risks and percutaneous nucleotomy is not an exception, but it is less invasive than open-field surgery so it has lower risks. It must be remembered, however, that its success rate is also lower.

WHAT WILL HAPPEN IF THE NUCLEOTOMY IS UNSUCCESSFUL?

All open-field surgery treatment options will still be available.

How can I get assistance?