- Nucleoplasty (also known as percutaneous discectomy) treats pain caused by herniated discs.
- A specially trained radiologist, using image guidance, removes a small amount of disc tissue to relieve pressure on the nerves.
- The treatment can reduce pain and restore mobility.
- Nucleoplasty is a “minimally invasive” procedure, which means a smaller incision, fewer risks of complication, and less recovery time than traditional surgery.
- We pay special attention to minimizing radiation exposure—without giving up image quality.
- Our state-of-the-art imaging technology plays a key role in planning and performing each procedure, and on-staff physicists and engineers ensure that our machines remain in top condition.
Nucleoplasty in depth
What is a herniated disc?
The discs function as shock absorbers between the vertebra of the spine. A herniated disc has a defect or weakness in the wall, similar to a “blister” in the sidewall of a tire, which can lead to pressure on sensitive nerve roots and pain receptors in the back.
Specialty expertiseNucleoplasty, also known as percutaneous discectomy, is a minimally invasive procedure for treating patients who are suffering from low back and leg pain caused by a herniated disc. It involves removing tissue from the disc to relieve pressure on the affected nerve.
The interventional radiologists who perform procedures at Mass General Imaging arespecialists in the area of the body and the condition under treatment, as well as the procedure itself. In addition to the training that all radiologists receive, these specialists have additional education, plus extensive real-world experience. In many cases, our doctors helped to pioneer many of the interventional treatments that we offer.
Our team of interventional radiologists and nurse practitioners coordinates a patient’s complete care—from imaging evaluation to post-procedure followup—maintaining a high level of communication with the patient throughout the process. In addition, Mass General Imaging works in close coordination with experts from across Mass General when necessary.
When should I consider nucleoplasty?
Candidates for nucleoplasty include men and women who have chronic back pain (at least six weeks) and debilitation due to disc herniation. Patients often have limited mobility and cannot perform routine daily activities, such as bathing, dressing and walking. Nucleoplasty is usually performed after conservative treatments (bed rest, back brace, oral pain medications) have failed. Most patients are elderly (average age 70 years), but younger patients with osteoporosis, due to metabolic disorders or long-term steroid treatment, may also benefit from nucleoplasty.
What should I expect BEFORE nucleoplasty?
All patients will be evaluated by one of our staff prior to nucleoplasty. Sometimes a telephone interview is sufficient, but usually you will be seen in person. The evaluation includes a directed history and physical examination and blood tests. Physicians also need to perform an imaging study prior to treatment to corroborate these findings.
At our initial evaluation, you should bring any imaging studies that were not performed at Massachusetts General Hospital. It is essential that you have recent plain radiographs and MRI. If MRI cannot be performed (due to a cardiac pacemaker, for example), CT scan is necessary. Some patients may need examination under fluoroscopy or bone scan.
What should I expect DURING nucleoplasty?
Nucleoplasty takes about an hour to perform. You will be given both a sedative to relax you and local anesthesia. Using live images, the interventional radiologist will place a needle into the disc, followed by a catheter. The doctor will then treat the disc, using either radio waves or heat to reduce the size of the disc and therefore relieve the pressure of the disc on the spinal nerve. Patients will experience relief as pressure is taken off the affected nerve, with published success rates greater than 80%.
What should I expect AFTER nucleoplasty?
After nucleoplasty, pain or weakness can be caused by a disc herniation pushing on a spinal nerve. You will be kept in the hospital for several hours of observation. You will be discharged with instructions to gradually re-establish normal activity over the next few days.
Facet joint injections usually have two goals: to help diagnose the cause and location of pain and also to provide pain relief:
- Diagnostic goals: By placing numbing medicine into the facet joint, the amount of immediate pain relief experienced by the patient will help determine if the facet joint is a source of pain. If complete pain relief is achieved while the facet joint is numb, it means that joint is likely a source of pain.
- Pain relief goals: Along with the numbing medication, a facet joint injection also includes injecting time-release steroid (cortisone) into the facet joint to reduce inflammation, which can sometimes provide longer-term pain relief.
The injection procedure may also be called a facet block, as its purpose is to block the pain.