Name of the Procedure:

Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, also known as Percutaneous Discectomy or Nucleoplasty.

Summary

In layman's terms, this procedure involves using a needle to remove a portion of the disc material from between the vertebrae to relieve pressure on the spinal nerves. It’s done with the help of imaging techniques like fluoroscopy to guide the needle precisely.

Purpose

This procedure treats conditions like herniated discs, which cause back pain and nerve compression. The primary goal is to reduce pain, improve mobility, and prevent further nerve damage by relieving the pressure on spinal nerves.

Indications

• Significant back pain unresponsive to conservative treatments (e.g., physical therapy, medications).
• Radiculopathy (nerve pain) due to herniated disc.
• MRI or CT evidence of disc herniation causing nerve compression.
• Patients without severe spinal instability or stenosis.

Preparation

• Fasting for 6-8 hours before the procedure.
• Adjustments in medication as advised by the physician (e.g., stopping blood thinners).
• Pre-procedure diagnostic imaging (e.g., MRI, CT scan).
• Blood tests to check for clotting ability or other potential issues.

Procedure Description

1. The patient is positioned properly on a fluoroscopy table.
2. Local anesthesia and possibly mild sedation are administered.
3. The skin over the treatment area is cleaned and sterilized.
4. Using fluoroscopy (X-ray), the physician inserts a needle into the affected disc.
5. Through the needle, specialized tools (e.g., a laser or radiofrequency probe) are used to remove or shrink the disc material.
6. Discography may be conducted to visualize internal disc structure.
7. Additional medications (e.g., steroids) may be injected to reduce inflammation.
8. The needle is removed, and the insertion site is bandaged.

Duration

The procedure typically takes about 30 minutes to an hour.

Setting

This procedure is usually performed in a hospital, outpatient clinic, or surgical center equipped with fluoroscopy.

Personnel

• Interventional radiologist or spine specialist (e.g., orthopedic surgeon, neurosurgeon).
• Radiology technician.
• Nurse or surgical assistant.
• Anesthesiologist if deeper sedation is required.

Risks and Complications

• Infection at the injection site.
• Bleeding or hematoma formation.
• Nerve damage.
• Discitis (disc infection).
• Allergic reaction to injected substances.
• Temporary increase in pain post-procedure.

Benefits

• Relief from chronic back and leg pain.
• Minimal invasion and shorter recovery time compared to open surgery.
• Improved mobility and quality of life.
• Immediate reduction in pain for many patients, though full benefits may take weeks.

Recovery

• Rest for the first 24 hours following the procedure.
• Gradual return to normal activities over a few days.
• Avoid heavy lifting, bending, or twisting for at least a week.
• Follow-up appointment within a week to evaluate outcomes.
• Physical therapy might be recommended to support recovery.

Alternatives

• Conservative treatments like physical therapy, chiropractic care, or medications.
• Epidural steroid injections.
• Open discectomy or spinal fusion surgery.
• Each alternative has its own pros and cons in terms of invasiveness, recovery time, and effectiveness, which should be discussed with your healthcare provider.

Patient Experience

• Mild discomfort or pain during needle insertion.
• Pressure or tingling sensation as disc material is removed.
• Post-procedure soreness at the injection site, typically managed with over-the-counter pain relievers or prescribed medication.
• Gradual improvement in symptoms over a few weeks with proper post-procedure care and physical therapy.