Coblation Nucleoplasty

 

Small to moderate low back disc herniations and disc degeneration may be treated with the Arthrocare Nucleoplasty technique.  Coblation refers to the low frequency radio waves (100kHz) used to carve channels into the disc by causing larger molecules to disintegrate into gases. This coblation process is used to decompress the disc under a herniation, allowing the pressure to be reduced on the herniation and on nerve roots thereby reducing pain.  Since October 2000, this outpatient one hour procedure has helped thousands nationwide avoid open surgical procedures.

Under sedation , an approach with the needle is made which avoids the spinal canal, and enters the disc.  The needle tip is placed in the outside lining of the disc and the nucleoplasty catheter is inserted.  The catheter is then activated and the coblation process begins which eradicates some of the disc.  On each withdrawal of the catheter, coagulation (heating) is used to shrink down the channel diameter, thereby decompressing the disc an additional amount.   Usually 6-12channels are made in the disc.   For patients with degenerative discs and annular tears, the tears themselves are targeted by using a steeper angle on the initial needle insertion. 

Alternatives to this procedure when used for herniated discs include selective endoscopic discectomy, microdiscectomy, discectomy/laminectomy, LASE.  Potential complications include dysesthesia (worsening pain temporarily on the needle entry side in 10%), nerve damage (rare), bleeding, infection.  Patients are usually discharged to home within one hour after the procedure is finished. There have been thousands treated with this technique so far with moderate to good results.  It was given approval by the FDA on the same basis as IDET and is more readily accepted than IDET since it has a defined CPT code.

 
 
                    
                  Normal Disc                    Contained Herniated Disc

WHAT IS IT?

Similar to the IDET procedure, a needle is inserted into the disc. Instead of a heating wire, a special radiofrequency probe is inserted through the needle into the disc. This probe generates a highly focused plasma field with enough energy to break up the molecular bonds of the gel in the nucleus, essentially vaporizing some of the nucleus. The result is that 10-20% of the nucleus is removed which decompresses the disc and reduces the pressure both on the disc and the surrounding nerve roots. This technique may be more beneficial for sciatica type of pain than the IDET, since nucleoplasty can actually reduce the disc bulge which is pressing on a nerve root. The high energy plasma field is actually generated at relatively low temperatures, so danger to surrounding tissues is minimized.

HOW LONG DOES IT TAKE?

The procedure takes 20 to 30 minutes, and the patient is ready to walk out of the clinic in about an hour with no hospital stay required. DISC Nucleoplasty percutaneous disc decompression is designed to offer a fast-acting option to drug therapies and steroid injections, on the one hand, and a minimally-invasive alternative to open surgery, on the other.

ARE THERE ANY POTENTIAL RISKS TO THE PROCEDURE?

There could be complications from Anesthesia and also from the procedure including discomfort, bruises, infection, bleeding and paralysis. But these are extremely rare if performed by a trained physician in an accredited facility.

 

 source:  http://www.nucleoplasty.com/dpat/dpat.aspx

 

 

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