Nucleoplasty

What is it?

Nucleoplasty is a percutaneous disc decompression procedure, meaning it is carried out through the skin with a needle. The needle reaches the soft, gel-like centre of the disc, known as the nucleus pulposus. A special probe passed through the needle uses coblation, a form of radiofrequency energy that works at relatively low temperatures, to remove a small amount of this tissue. The aim is to lower the pressure inside the disc and ease the pressure that the bulging part places on a nerve root.

The procedure is used to treat lumbar disc herniation and cervical disc herniation. It does not require a surgical incision; it is performed through a needle under imaging guidance. To see where it fits in a stepwise plan, see non-surgical lumbar disc treatment and non-surgical cervical disc treatment.

When is it considered?

Nucleoplasty is suitable only in selected cases where the herniation is still contained within the outer ring of the disc. When a fragment has broken free, or the herniation fills much of the spinal canal, reducing the pressure inside the disc is not expected to help. It is also unsuitable for severely worn discs that have lost much of their height.

The decision is based on your symptoms, the neurological examination and your MRI findings taken together. It matters that your pain follows the path of the nerve root at the level of the herniation seen on MRI. If these conditions are not met, other options are discussed.

The evidence shows that pain can be meaningfully reduced in carefully selected patients, although the overall quality of the studies is moderate. The UK's National Institute for Health and Care Excellence (NICE) states that the procedure can be used with normal arrangements for clinical governance, and that patients should be told about other treatment options and the possibility of needing further procedures.

How does it work?

A disc is made up of a gel-like core surrounded by a tough, fibrous ring. When the ring weakens, the core can bulge outwards and press on a nerve root. In nucleoplasty, a few small channels are created in the core and some tissue is removed; as the probe is withdrawn, the channel walls are shrunk with gentle heat. This lowers the pressure inside the disc, which is expected to reduce the pressure on the nerve.

Coblation works at lower temperatures than conventional heat-based techniques, which helps limit the effect on surrounding tissue. The procedure does not change the whole structure of the disc, so the herniation may still be visible on a later MRI. What matters most is the change in your symptoms.

Before the procedure

Before the procedure, your examination and recent MRI are reviewed together, and further imaging or blood tests are requested if needed. You and your doctor will plan how to manage blood thinners and your other regular medicines. A preventive antibiotic may be given beforehand to lower the risk of disc infection.

The aim of the procedure, its expected benefits, possible risks and the alternatives are explained in detail before you give written consent. If sedation is planned, you will be asked to fast for a few hours beforehand.

What happens during the procedure?

For a lumbar procedure you lie face down, and the needle is guided into the disc from the side at an angle that keeps it away from the nerve roots. For a cervical procedure you lie on your back and the disc is approached from the front. The doctor gently moves the windpipe, oesophagus and carotid artery apart with the fingers to create a safe path. The needle position is checked on fluoroscopy from different angles.

Once the probe is in the disc, a brief stimulation test may be done before any energy is delivered. If you feel new pain, burning or an electric sensation in your leg or arm, tell the team straight away; this helps show whether the probe is too close to a nerve root. Depending on how many levels are treated, the procedure usually takes between half an hour and an hour.

After the procedure

You will be observed for a while after the procedure, and most people go home the same day. Pain, tenderness and muscle spasm around the needle site are common in the first days and usually ease over a few days to a few weeks. The painkillers your doctor recommends and cold packs can help during this time.

Short walks are encouraged. For the first few weeks, avoid heavy lifting, sudden twisting and sitting for long periods. Many people can return to desk work within a few days, while heavy physical work may need longer. Exercise is introduced when your doctor advises.

When might you notice results?

Some people notice relief in the first few days, but the effect often develops gradually over several weeks. Temporary pain from the procedure itself can make the early days hard to judge, so the outcome is usually assessed at a follow-up visit a few weeks later.

Results vary from person to person. If pain does not ease enough, other interventional options such as an epidural steroid injection, or surgery, may be considered; where surgery is needed, the decision is made together with a spinal surgeon. To find out whether your herniation is suitable for this procedure, you can request a consultation.