Nucleoplasty for Lumbar Disc Herniation

Transcript translated from Turkish (video audio remains in Turkish)

Nucleoplasty, particularly preferred for central lumbar disc herniations, is performed under imaging guidance and local anaesthesia. After a special electrode is placed inside the disc, a current called radiofrequency, similar to intermittent radio waves, is applied.

The aim is to reduce pressure within the disc so that the herniated part retracts towards the disc space, relieving the pressure on the nerve that causes pain. The procedure takes 15 to 20 minutes.

What Is Nucleoplasty?

Nucleoplasty is a non-surgical algology procedure (interventional pain treatment) for lumbar disc herniation that lowers pressure within the disc to relieve nerve compression.

How Does Nucleoplasty Work?

It lowers pressure within the disc, reducing the pressure of protruding disc tissue on the nerve and easing pain.

• Pressure Reduction: Energy delivered through the needle (plasma/radiofrequency/laser) reduces disc volume and pressure in a controlled manner.
• Reduced Nerve Compression and Pain: As pressure falls, the protruding disc tissue exerts less pressure on the nerve root responsible for radiating leg and lower back pain.

How Is Nucleoplasty Performed?

Under imaging guidance, a fine needle (cannula) enters the disc, and cold plasma, laser or radiofrequency energy reduces pressure within it.

• Preparation: No extensive preparatory stage is needed.
• Type of Anaesthesia: The procedure is performed in an operating-theatre setting under local anaesthesia, numbing only the relevant area. A light sleep-like state (sedation) can also be provided if needed.
• Duration: The entire procedure takes an average of approximately 30 minutes.
• Discharge and Recovery: Following approximately 1–2 hours of clinical observation, our patients can walk home the same day. Only 2 days of rest at home are recommended afterwards.

Can Nucleoplasty Free Patients from Lumbar Disc Herniation? (Success Rates)

Yes: in a Turkish study of 52 patients, the pain score out of 10 fell from 7.5 to 2.1 at one year, and 94% stopped or reduced pain medication [3]. With appropriate selection, nucleoplasty is an effective non-surgical option for unruptured (contained) lumbar disc herniation. Studies show long-term pain reduction, although most lack a comparison group [2, 4]. In a five-year follow-up of patients with chronic lower-back pain not due to herniation, satisfaction fell from 88% to 63% [5].

What Are the Risks and Side Effects of Nucleoplasty?

Risk is low: the overall complication rate for lumbar nucleoplasty was 1.8%, and the great majority of reported events were mild and temporary [2]. It is performed with imaging guidance. Because a fine needle enters the disc space, the risks of tissue adhesions (epidural fibrosis) and extensive tissue damage seen with open surgery are much lower. Serious complications such as nerve injury or disc-space infection (discitis) have appeared only in rare case reports [2, 4].

Which Herniations and Patients Are Suitable for Nucleoplasty?

Unlike targeted treatment (epidural injection), nucleoplasty is not suitable for every lumbar disc herniation; it is used only for small or medium-sized, unruptured (contained) herniations. Disc structure and the degree of herniation limit its use. Studies found the best results in herniations smaller than 6 mm, with at least 50% of disc height preserved relative to adjacent discs and an intact outer disc membrane (annulus fibrosus) [3]. Results are poorer in advanced disc degeneration [5].

Who Is Not Suitable for Nucleoplasty?

• Ruptured (extruded) herniations or those with a detached fragment (sequestered).
• Worn (degenerated) discs with reduced height and disrupted integrity.
• Patients with a high bleeding risk and severe metabolic problems.

Which Patients Are Suitable for Nucleoplasty and Which for Targeted Injection?

Nucleoplasty is used only for unruptured herniations, whereas targeted treatment (epidural injection) can be used for a much broader group, including patients with ruptured herniations. Epidural injection directly targets swelling and inflammation around the nerve root independently of disc structure, so it can also be used for ruptured herniations, degenerated discs and cases with accompanying canal narrowing. Epidural injection is therefore preferred for most patients needing non-surgical treatment, while nucleoplasty is reserved for a selected group.

🩺 Physician’s Insight & Clinical Experience

“As a physician who has extensively used both surgery and interventional pain treatments for spinal conditions for many years, I must emphasise that nucleoplasty is an effective method that saves a patient from an operation when used for the right indication, but it is not suitable for every patient with lumbar disc herniation. A proportion of patients requiring non-surgical treatment are suitable for it. Its success lies in selecting the right patients, whose herniation has not yet ruptured (disc integrity is preserved) and whose nerve compression is identified at an early stage.”

Frequently Asked Questions

What Is Nucleoplasty, and How Is It Performed?

Nucleoplasty is a non-surgical treatment for lumbar disc herniation in which a fine needle is inserted into the disc to reduce internal pressure. It is performed under local anaesthesia with imaging guidance.

What Is the Success Rate of Nucleoplasty?

Of patients receiving nucleoplasty, 56% needed no additional procedure within two years (versus 28% after repeated injection) [1]. In a Turkish study, 94% had stopped or reduced pain medication at one year [3].

Does Nucleoplasty Have Risks or Side Effects?

Yes, but they are low: the complication rate for lumbar nucleoplasty is 1.8%, and most events are mild and temporary [2].

When Does Nucleoplasty Take Effect?

The effect usually appears within one to two weeks after the procedure.

Does Nucleoplasty Eliminate the Herniation?

No. It does not cut out the herniation; it reduces pressure within the disc to relieve pressure from the protruding tissue on the nerve.

How Many Sessions of Nucleoplasty Are Performed?

Nucleoplasty is performed in one session.

Does Nucleoplasty Work for a Ruptured Disc?

No. In a ruptured (extruded) herniation or one with a detached fragment (sequestered), the outer disc membrane has torn, so reducing internal disc pressure does not affect the herniation. Targeted treatment (epidural injection) is used as an interventional pain treatment for ruptured herniations.

Can I Travel by Plane or Bus After Nucleoplasty?

Yes, a short flight is possible 48 hours after the procedure. For long bus journeys, waiting 1 week and ensuring spinal support is more comfortable while nerve swelling settles.

Can I Have Surgery If Nucleoplasty Does Not Help?

Yes. The method does not disrupt the anatomical integrity of the spine or damage bone tissue. It therefore does not prevent a microsurgical procedure that might be required later.

Is There a Risk of Nerve Damage or Paralysis During Nucleoplasty?

The risk of paralysis is very low. Serious nerve injury has only been described in rare case reports [2, 4].

Will I Feel Pain During Nucleoplasty?

You feel brief stinging or pressure; pain is usually mild and short-lived because local anaesthesia is used. Light sedation (a relaxed, sleepy state) may be given for comfort if needed.

What Is the Difference Between Nucleoplasty and Targeted Treatment (Epidural Injection)?

Targeted treatment (epidural injection) addresses inflammation and swelling around the nerve; nucleoplasty lowers pressure within the disc. Targeted treatment can therefore be used in a much broader group of patients, whereas nucleoplasty is used only for unruptured herniations with preserved disc height.

How Long Does Nucleoplasty Take?

It takes approximately 30 minutes.

How Long Must I Stay in Hospital Afterwards?

No hospital admission is needed; patients go home the same day after approximately 1–2 hours of observation.

What Should I Do After Nucleoplasty, and When Can I Return to Work?

After 2 days of rest at home, patients can return to desk work and daily activities on day 3. Resuming vigorous exercise or activities involving heavy lifting is planned after the follow-up examination.

Which Specialist Performs Nucleoplasty in Istanbul?

One of the physicians performing nucleoplasty in Istanbul is M. Levent Deniz, MD, a specialist in neurosurgery.

How Much Does Nucleoplasty Cost?

As treatment costs vary according to the patient and hospital conditions, a definite fee can only be determined after examination and review of imaging.

References

1. Gerszten PC, Smuck M, Rathmell JP, et al. Plasma disc decompression compared with fluoroscopy-guided transforaminal epidural steroid injections for symptomatic contained lumbar disc herniation: a prospective, randomized, controlled trial. J Neurosurg Spine. 2010;12(4):357-371. PMID: 20201654. PubMed
2. Eichen PM, Achilles N, Konig V, et al. Nucleoplasty, a minimally invasive procedure for disc decompression: a systematic review and meta-analysis of published clinical studies. Pain Physician. 2014;17(2):E149-E173. PMID: 24658486. PubMed
3. Mirzai H, Tekin I, Yaman O, Bursali A. The results of nucleoplasty in patients with lumbar herniated disc: a prospective clinical study of 52 consecutive patients. Spine J. 2007;7(1):88-92. PMID: 17197339. PubMed
4. Gerges FJ, Lipsitz SR, Nedeljkovic SS. A systematic review on the effectiveness of the Nucleoplasty procedure for discogenic pain. Pain Physician. 2010;13(2):117-132. PMID: 20309378. PubMed
5. Ren DJ, Liu XM, Du SY, Sun TS, Zhang ZC, Li F. Percutaneous Nucleoplasty Using Coblation Technique for the Treatment of Chronic Nonspecific Low Back Pain: 5-year Follow-up Results. Chin Med J (Engl). 2015;128(14):1893-1897. PMID: 26168829. PubMed

• 👨‍⚕️ Author and medical reviewer of this content: M. Levent Deniz, MD – Neurosurgery Specialist
• ⚠️ Medical Disclaimer: This page is for information only; consult your doctor for diagnosis and treatment.