The International Spine Centre

12 Walter Street, North Adelaide South Australia 5006
P: (08) 8239-1889
F: (08) 8239-2203

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(08) 8239 1889

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Low back pain associated with sciatica (pain radiating from the lower back to one or both legs) is generally due, in the active adult population, to protrusion/prolapse of one or more lumbar intervertebral disc/s. This large cartilaginous and avascular structure, as a result of genetically pre-determined and time dependent degeneration, gradually loses water, therefore fraying and cracking and allowing portions of its inner core (nucleus pulposus-inner annulus fibrosis) to displace posteriorly and interfere with one or more nerve roots(sciatic nerve).

In most cases, the acute pain felt in the back and radiating to the buttock and/or the leg settles spontaneously within weeks. In a minority of individuals, however, the pain may persist despite rest, analgesia, anti-inflammatories and minimally invasive techniques such as steroid injections (epidural and/or nerve root blocks).


In selected cases, it may be reasonable to consider percutaneous decompression of the bulging disc causing the sciatic symptoms by coblation (thermal energy). This technique (nucleoplasty) is indicated in individuals with back and leg pain caused by proven contained disc protrusions if symptoms persist over a number of weeks and if more aggressive treatment options such as microsurgical decompression may not be appropriate.

Percutaneous disc decompression (nucleoplasty) is carried out under neuroleptic intravenous sedation administered by an Anaesthetist, in a surgical theatre as a day patient procedure without overnight stay.

The patient is positioned prone on a radiolucent table and following preparation of the skin with standard antiseptic, using a thorough sterile technique, a thin probe is inserted through the skin into the selected disc/s under fluoroscopy (special X-ray machine). Local anaesthetic is used to numb the area where the probe is inserted to minimise any discomfort to the patient. Once the probe is in position, coblation is applied with a temperature at the tip of the probe ranging from 40 – 70° centigrade creating channels within the disc which allow shrinkage of the cartilage material which causes pressure onto the disc.

The procedure generally takes no more than 30 minutes to be completed and in most cases the patient is discharged from hospital within an hour or so. No stitches are required and the patient is instructed to rest for 24 hours and then return to normal daily activities and/or work, if comfortable, within 2 or 3 days.


Numerous clinical studies have been carried out over the last few years on this procedure. The Specialists’ advisors of the National Institute for Health and Clinical Excellence of the National Health Service(NHS) of the United Kingdom ( have stated that “although nerve root damage, infection, haemorrhage and worsened pain were listed as potential complications, in a large case series of 1390 patients, no operative complications were reported”.

The reported efficacy of the procedure, according to the National Institute for Health and Clinical Excellence of the NHS, has ranged in published series from 50% at one year to 75% in another series with the same follow up. Caution was suggested in interpreting these data “due to the lack of controls and/or long term and comparative results”.

My opinion on nucleoplasty is that it is safer than open surgery and that in selected cases the results can be satisfactory. The overall success rate may be estimated at just above 70%. This technique does not preclude open disc surgery if required in the absence of any symptomatic improvement.

Contra-indications for nucleoplasty include large disc protrusions with sequestrated (separated) disc fragments, progressive neurological deficit with increasing weakness and/or numbness in the leg and/or bladder disturbance, associated spinal stenosis (bony narrowing) compounding the disc protrusion, segmental instability (spondylolisthesis, fractures, etc), infection and previous surgery at the level to be treated.

As for any other spinal procedure, great caution should be taken in carrying out this technique in individuals with mental dysfunction such as depression/anxiety. In addition the presence of litigation (compensation claim) is generally associated with a lower success rate. The procedure is not indicated in individuals with one or more disc bulges if symptoms are confined to the lower back, in the absence of any referred pain to the buttock and/or the leg.

If effective, symptoms should improve within a period of 2-4 weeks after nucleoplasty although no definitive assessment of its efficacy should be carried out for a period of at least 3 months.

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