What is percutaneous nucleotomy?

Sometimes back pain and neurological deficits cannot be controlled with conservative drugs - either with rest, painkillers or physiotherapy, which means it is necessary to act against the reason of pain. Your specialist will decide after the most accurate diagnosis whether a so-called 'open' intervention is useful and necessary to treat the herniated disc, or if there is a minimally invasive alternative. Such an alternative is the percutaneous (= through the skin) nucleotomy (= the nucleotomy is a treatment for a herniated disc). A nucleotomy is necessary if nerves are pinched off or pressed by the prolapsed parts of the disc, causing muscle paralysis, numbness, tingling or urinary and fecal incontinence). This method is an option that can be used on the cervical spine (cervical spine) and the lumbar spine (lumbar spine). However, because this surgery method cannot be used in all stages of the disease, imaging (computed tomography or magnetic resonance tomography) must first give the go-ahead for this patient-friendly procedure.

The minimally invasive procedure takes about 30-45 minutes, and he has the great advantage that the spinal canal will not be opened and that the intervertebral disc must not be replaced by a placeholder (cage, bone block, prosthesis). It is not about removing the entire intervertebral disc during the percutaneous nucleotomy process - rather shall be removed intervertebral disc tissue, because it will free and relieve the stressed nerve root. The therapeutic effect, however, remains untouched by this minimally invasive procedure. During the procedure, the specialist must work with a very thin probe, because the work area is very tight.

When is the percutaneous nucleotomy recommended?

Percutaneous nucleotomy is primarily used for disc protrusions and more or less large disc herniation. This procedure eliminates the cause of the pain without unnecessarily injuring the surrounding tissue.

Operation procedure - removal of the herniated disc

In this technique, the patient lies on his stomach when lumbar spine affected – which means the approach is from behind (dorsal). Once the local anesthesia is effective and the anesthesiologist (stand-by) gives the green light, the procedure begins. We push (percutaneously - under the skin) before a very thin cannula, whereby a rotating spiral needle or a fine forceps is inserted to center of the Protrusion or prolapse. After all, it's not about removing the entire disc as usual and replacing it with a placeholder (cage, bone block or prosthesis) - we just want to shrink the disc protrusion. The entire operative process is visible to us through an X-ray inspection. As soon as we are at the protrusion or prolapse with our instruments specially made for such procedures (forceps, miniature forceps, spiral needle), we can remove the center of the protrusion. As a result, the affected nerves root are free and the pain practically subsides.

 

 

 

Right after the operation

As it is well known that percutaneous nucleotomy is not performed under general anesthesia, but only under local anesthesia, you are also quick to return to your activities. Nevertheless - it is and remains an intervention, and then you need rest: lie down, sleep, let yourself be pampered by our friendly and attentive nursing staff. On the day of the procedure a relative bed rest is arranged.

Post-operative days

Your inpatient stay will be of about 5-7 days. Your employer will have to do without you for about 2-4 weeks- as long as you are on sick leave. A bandage for the lumbar spine or a neck brace for the cervical spine (cervical spine) will be necessary for three-four weeks. Of course, physiotherapy is part of the sensible rehabilitation process. Shortly after the percutaneous nucleotomy you can walk, but cycling is only allowed after 3-4 weeks. Playing golf? 6-10 weeks! Avoid heavy activities for a few weeks – which means do not lift or drag anything heavy.

Advantages/Complications - percutaneous nucleotomy (almost) only has advantages

Percutaneous nucleotomy has many advantages:

  • General anesthesia is not necessary.
     
  • Risks of adhesions are low because this treatment does not injure surrounding structures - neither bone nor ligaments or the spinal canal.
     
  • Discs enjoy their full mobility - this treatment does not cause degeneration in the adjacent discs.
     
  • Patients also have the advantage of a short convalescence phase, which means that their usual activities can be resumed soon.
     
  • Percutaneous Nucleotomy is a less traumatic alternative to open surgery.
     
  • The risks are much lower than with open surgery.
  • The effectiveness is at least as high as in an open operation. In about 80% of the patients wonderful  and long lasting results could be achieved.
     
  • The risks of a relapse (new herniated disc) is very low.
Dr. med. Munther Sabarini

Author
Dr. med. Munther Sabarini
Specialist in Neurosurgery

Hans-Heinrich Reichelt

Co-author
Hans-Heinrich Reichelt
Chief Editor of Medizin für Menschen

The Avicenna Clinic in Berlin is always willing to help you

Since the year 2001, the Avicenna Clinic is based in Berlin. Our doctors have at least 25 years of international experience in their respective fields (neurosurgery, spinal surgery, anesthesia, and orthopedics).

If you have severe back pain, a herniated disc or a suspected herniation, please contact us using the following information:

Avicenna Clinic
Paulsborner Str. 2
10709 Berlin

Telephone: +49 30 236 08 30
Fax: +49 30 236 08 33 11
E-Mail: info@avicenna-klinik.de

You can call anytime, write an e-mail or fill out a callback form. Each patient then gets an appointment with a doctor of our clinic, who is a spine specialist (neurosurgeon). Based on MRI images (brought or made in our clinic) and on an in-depth examination, the doctor will discuss with you all the different therapy options or possibly surgery. You can also use our specialists only to obtain a (second) opinion.

If you decide to undertake your therapy and/or surgery in Berlin, we would want to make your stay as pleasant as possible. In our clinic, you are at the center of our attention! You can expect state-of-the-art equipment in all areas - from the operating room to the patient bedroom.

The latest, gentle, minimally invasive treatment procedures are the focus of our clinic. Together we try to find a suitable treatment for your complaints. The actual therapy takes place only after a detailed discussion with the patient, examinations and the diagnostics.

For us, as important as medical care, it is the commitment we take to guarantee our patients a high level of personal care that can, in turn, ensure them a comfortable stay.

During the period of inpatient stay our team of nurses will take care of you 24 hours a day. They also offer services in several foreign languages, including English, Russian, Polish, Turkish, Spanish, Italian, Arabic, Bulgarian and French. We care not only about your safety but also your needs, respecting traditions and religions.

Our team is made up of a group of highly qualified specialists who work together to guarantee you a quick recovery.