Nucleoplasty and IDET

How does it work?
Leg pain with or without back pain, originating from a disc herniation, can be treated with minimally invasive percutaneous (through the skin) techniques such as chemonucleolysis, automated percutaneous lumbar discectomy, laser discectomy and nucleoplasty. Each technique has advantages and disadvantages and should be individually applied to each patient, based on the clinical presentation.

Nucleoplasty utilizes a Perc-D Spine Wand, which is a 1 mm diameter bipolar instrument designed for decompression of the disc nucleus, using energy and heat.

Initially a so called "ablation lesion" is created by advancing the wand in a controlled manner into the nucleus. After this, the wand is withdrawn and bipolar coagulation is performed. The thermal effect produces a denaturization of the inner disc proteins (collagen) leading to shrinkage and widening of the previously created channel. As a result, the pressure and volume inside the disc are reduced. A total of 6 similar "lesions" are induced. Throughout this phase, the patient usually perceives minimal discomfort.

Intradiscal electrothermal annuloplasty (IDET) began to be performed in 1998. The concept behind this procedure is that thermal heating of the posterior annulus (a component part of the disc) can seal and destroy nerves to the annulus responsible for the propagation of the pain from the disc to the central nervous system. Candidates for this procedure are usually young patients who have predominant mid axial pain with little or no radiation to the legs. These patients need to undergo a discogram prior to this intervention. Given the alternatives of a spinal fusion (major surgery with considerably more morbidity and mortality) or doing nothing, an IDET procedure becomes an attractive alternative for this subgroup of patients. At present time we have no studies showing long-term efficacy (beyond 5 years) of this procedure. Present studies, however, show a 75% chance of improvement lasting one or two years after the procedure. Possible complications, albeit rare, should be discussed prior to undergoing a nucleoplasty or IDET procedure.

What to expect during the procedure?
The patient is placed in a face down position. The appropriate area is prepped with an antiseptic solution and then a local anesthetic is used to numb the skin. A light sedative is usually administered, but the patient remains awake. Under direct X-ray visualization a needle is introduced towards the targeted disc area. A mild, temporary discomfort may be perceived at this time. The specific catheter for either nucleoplasty or IDET is deployed through the needle to the desired area of the disc and the procedure is completed: the channels are created as described above during nucleoplasty. During the IDET procedure, heating of the annulus takes place for 16 minutes.

Strenuous activities are to be avoided in the first few months after the procedure and a rehabilitation program is started. After the IDET a back brace is prescribed for the first month to decrease possible muscle spasm. Discharge instructions are given and a follow up scheduled within one month.