Introduction

Intervertebral discs are cushion-like structures that are located between the bones that make up the spine.  Under certain conditions, the discs can bulge and cause back pain.  Percutaneous disc nucleoplasty is a minimally invasive procedure used to reduce the pressure inside a disc to relieve pain.  Because no incision is used, the recovery time is shorter and easier than with traditional open surgery methods.

Anatomy

Intervertebral discs are cushions located between the series of bones (vertebrae) that compose the spine.  The discs act as a shock absorber between the bones, while providing stability and allowing movement.

Discs are made out of strong connective tissue.  Their tough outer layer is called the annulus fibrosis.  The center of each disc, the nucleus pulposus, is cushion-like because it is mostly fluid.

Causes

With age, discs lose water content and become more narrow, less flexible, and less effective as cushions between the vertebrae.  As a disc deteriorates, the outer layer can weaken, bulge, or tear.  A herniated disc occurs when the outer layer ruptures and the inner fluid leaks out.

Disc problems are more common among people that are middle-aged.  Older adults are at the greatest risk for herniated discs because of decreased disc water content.  Other risk factors include being overweight and smoking.  Using poor body posture when lifting or performing repetitive strenuous activities can also cause discs to bulge or rupture.

Symptoms

Disc problems can cause neck or back pain, burning or tingling sensations, numbness, weakness, or shooting pain.  Depending on the location of the disc in the spine, your symptoms may spread to your arms or legs.

Diagnosis

Your doctor can diagnose a bulging or herniated disc by performing a physical examination, viewing medical images, and conducting nerve studies.  Your doctor will ask you about your symptoms and medical history.

There are several treatments for disc problems.  A minimally invasive procedure called Percutaneous disc nucleoplasty can be appropriate for discs that have bulged but have not ruptured.  Your doctor will let you know if you are a candidate for percutaneous disc nucleoplasty.

Treatment

Percutaneous disc nucleoplasty is a minimally invasive outpatient procedure.  You will wear a gown and be positioned lying face down.  Your skin in the treatment area will be sterilized and numbed with an anesthetic.  You may receive relaxing medication before the procedure.

To begin, your doctor will use a live X-ray image (fluoroscope) to guide a thin tube-like cannula to the bulging disc.  Next, a narrow radiofrequency device is inserted through the cannula.  The device transmits radio waves that dissolve small areas of the nucleus pulposus.  In turn, this creates space for the nucleus’ contents to spread into, reducing pressure in the disc and decreasing the disc bulge.  When the procedure is complete, the cannula and radiofrequency devices are removed.  Because a tiny incision is required for this procedure, there are no stitches and the insertion point is simply covered with a small bandage.

You should have another person drive you home if you received relaxation medication.  Most people need about a day of bed rest following a percutaneous disc nucleoplasty.  Physical therapy typically follows the procedure.  Recovery from percutaneous disc nucleoplasty is individualized.  People typically return to their prior activity levels within one to six weeks.