PLEASE RESPOND REGARDING NUCLEOPLASTY. I WOULD LIKE TO KNOW IF ANYONE HAS HAD THE PROCEDURE AND WHAT WAS THEIR OUTCOME SO FAR. IF YOU HAD THIS PROCEDURE, WERE YOU CONCERNED ABOUT THEM TAKING THE DISC MATERIAL OUT, THAT THIS MAY SPEED UP THE DEGENERATIVE PROCESS OF THE DISC FOR POSSIBLE FUTURE PROBLEMS? SEVERAL SPINE SURGEONS HAVE TOLD ME THIS. I AM DECIDING TO EITHER GET A NUCLEOPLASTY OR A MICRODISCECTOMY (WAS TOLD BY ANOTHER DOCTOR THAT SINCE MY DISC IS CONTAINED, YOU DON'T WANT TO GET THE MICRODISCECTOMY BECAUSE IT IS NOT FOR CONTAINED HERNIATED DISCS, ONLY RUPTURED ONES). As most of you know, the nucleoplasty is for contained herniated discs. I am still concerned about the jelly being taken out.
Does anyone have any thoughts on this? I have a contained herniated disc at L5-S1 with No nerve damage in my right leg.

Hi MPT http://www.healthboards.com/ubb/wave.gif

I was scheduled to have Nucleoplasty done back in May but, I had a Intral-Discal injection 2 weeks prior to the scheduled procedure to rule out which disc was causing me the most problems. The injection itself actually gave me some relief for a couple of months so, I decided to put off the procedure....because I thought, why mess up a good thing?? Well, the pain decided to come back, and now I am back to were I started!

I have 2 torn/ruptured/herniated discs at L4-L5 & L5-S1 that are contained. I was told that Nucleoplasty would be the best procedure for me. I was told by my doctor, that you should ONLY have this procedure done if you experience leg pain because, Nucleoplasty helps with the leg pain, but does nothing for the back pain.

As far as disc material being removed, that too has been a major concern for me. I think I am more concerned about the amount of material being removed from the disc. I guess I am scared that they might take to much material out, and then I will be bone on bone with no cushion between!

A thread was started from Kenneth, who had the procedure done yesterday. I am hoping that he posts his recovery and lets us know how everything went. The amount of material being removed, was a concern for Ken and I, several months ago. I know we spoke about this in a prior thread several months ago. Maybe you can do a search and get some information on this. Disc material is removed by the amount of "Passes", I guess you could ask your doctor how many "passes" he will make.

I am sorry that I don't have that much information for you, but I wanted to let you know that you and I are in the same boat!

Take care and I hope you find the answers you are looking for.

Take care,
Bcorica

HI BCORICA,
FIRST OFF, I JUST WANT TO THANK YOU FOR REPLYING. THIS WAS MY THIRD POST.
YOU HAD MENTIONED THAT YOUR DISCS WERE CONTAINED. BUT BEFORE THAT YOU SAID THEY WERE TORN AND RUPTURED. TO MY UNDERSTANDING, WHEN YOU HAVE A TEAR, THE DISC IS NOT CONTAINED. MY DOCTOR EXPLAINED IT THAT ALL THE JELLY IS STILL INSIDE THE DISC AND HAS NOT LEAKED OUT. WHEN YOU HAVE AN ANNUAL TEAR IS WHEN THE JELLY STARTS TO COME OUT. THERE IS A NUCLEUS WHICH IS THE CORE OF THE DISC(WHERE THE JELLY IS) AND THEN THERE IS THE ANNULUS (WHICH IS A FIBROUS RING ON THE OUTSIDE OF THE DISC). THE ANNULUS IS WHERE THE TEARS ARE.
DID ANY DOCTOR EVER ADVISE A MICRODISCECTOMY, A MINIMALLY INVASIVE PROCEDURE WHERE THEY MAKE A SMALL INCISION MOVE AWAY THE MUSCLES AND TAKE A PIECE OUT OF THE DISC THAT IS CAUSING PRESSURE ON THE NERVE? ANOTHER DOCTOR TOLD ME THAT YOU DON'T WANT TO HAVE THIS SURGERY ON A CONTAINED DISC BECAUSE IT WILL CREATE A HOLE IN THE ANNULUS AND CAUSE DEGENERATION TO SPEED UP. IT SEEMS LIKE BOTH HAVE THEIR PROS AND CONS. THAT IS WHY I AM HAVING SUCH A DIFFICULT TIME MAKING A DECISION. I SPOKE WITH A DARREN CRAWFORD AT ARTHROCARE (THE COMPANY THAT MAKES THE INSTRUMENTS FOR THE NUCLEOPLASTY. HE CONFIRMED WHAT I KNEW ABOUT THE NUCLEOPLASTY AND TOLD ME THAT THEY SHOULD NOT TAKE OUT MORE THAN 5-10% OF DISC MATERIAL. ALSO, THAT DISC HEIGHT SHOULD NOT HAVE DECREASED BY NO MORE THAN 25% OR YOU ARE NOT A CANDIDATE FOR THE PROCEDURE.
HOPE THIS HELPS YOU AS WELL. HIS EMAIL ADDRESS IS DCRAWFORD@ARTHROCARE.COM THEIR NUMBER IS 1-800-797-6520.
KEEP IN TOUCH
MPT

HI BCORICA,
FIRST OFF, I JUST WANT TO THANK YOU FOR REPLYING. THIS WAS MY THIRD POST.
YOU HAD MENTIONED THAT YOUR DISCS WERE CONTAINED. BUT BEFORE THAT YOU SAID THEY WERE TORN AND RUPTURED. TO MY UNDERSTANDING, WHEN YOU HAVE A TEAR, THE DISC IS NOT CONTAINED. MY DOCTOR EXPLAINED IT THAT ALL THE JELLY IS STILL INSIDE THE DISC AND HAS NOT LEAKED OUT. WHEN YOU HAVE AN ANNUAL TEAR IS WHEN THE JELLY STARTS TO COME OUT. THERE IS A NUCLEUS WHICH IS THE CORE OF THE DISC(WHERE THE JELLY IS) AND THEN THERE IS THE ANNULUS (WHICH IS A FIBROUS RING ON THE OUTSIDE OF THE DISC). THE ANNULUS IS WHERE THE TEARS ARE.
DID ANY DOCTOR EVER ADVISE A MICRODISCECTOMY, A MINIMALLY INVASIVE PROCEDURE WHERE THEY MAKE A SMALL INCISION MOVE AWAY THE MUSCLES AND TAKE A PIECE OUT OF THE DISC THAT IS CAUSING PRESSURE ON THE NERVE? ANOTHER DOCTOR TOLD ME THAT YOU DON'T WANT TO HAVE THIS SURGERY ON A CONTAINED DISC BECAUSE IT WILL CREATE A HOLE IN THE ANNULUS AND CAUSE DEGENERATION TO SPEED UP. IT SEEMS LIKE BOTH HAVE THEIR PROS AND CONS. THAT IS WHY I AM HAVING SUCH A DIFFICULT TIME MAKING A DECISION. I SPOKE WITH A DARREN CRAWFORD AT ARTHROCARE (THE COMPANY THAT MAKES THE INSTRUMENTS FOR THE NUCLEOPLASTY. HE CONFIRMED WHAT I KNEW ABOUT THE NUCLEOPLASTY AND TOLD ME THAT THEY SHOULD NOT TAKE OUT MORE THAN 5-10% OF DISC MATERIAL. ALSO, THAT DISC HEIGHT SHOULD NOT HAVE DECREASED BY NO MORE THAN 25% OR YOU ARE NOT A CANDIDATE FOR THE PROCEDURE.
HOPE THIS HELPS YOU AS WELL. HIS EMAIL ADDRESS IS DCRAWFORD@ARTHROCARE.COM THEIR NUMBER IS 1-800-797-6520.
KEEP IN TOUCH
MPT

Hi MPT http://www.healthboards.com/ubb/wave.gif

In my prior post, I did say that both my discs were contained. Let me correct myself, my L5-S1 disc tear is contained, but not my L4-L5 disc tear.

It is not always true that if your disc are torn, that they are not contained. My L5-S1 is torn, but it is a circumfrential tear. Which means, that it isn't torn at the annular wall itself, and therefore it is not leaking. It is a huge tear that actually goes almost all the way around the annular. I believe that this disc that is causing me all my back pain.

As far as my L4-L5 disc tear is concerned, the disc tear at this level is allowing the jelly like material to leak outside the annular wall. This is the disc that I believe is causing me all of my problems such as my, hip, groin, leg and buttock pain.

As far as being offered a Microdiscetomy, that was never a option. It was suggested that I have either Nucleoplasty or Disc replacement done.

I hope that in time that you will be able to make the best decision for yourself as far as your options are concerned. All surgeries have their pros and cons, and they also come along with no guarantee's.

I am in the ame position that you are at this moment, in not knowing what to do. I would also like to thank you for all the valuable information. I think I will give Mr. Crawford a call.

Please keep me posted on your decision and good luck.

Take Care,
~Brenda http://www.healthboards.com/ubb/heart.gif

hey there...I had the nucleoplasty done 2 weeks ago L5/S1 with 2 annular tears...next step is disk replacement...I hear its an amaizing thing...I had asked my doc. why not just go for it...after all with all the pain I was/am in I just wanted it over...taking all the little steps was frustrating...but he wanted to be conservative...So now Im two weeks out of what I thought was a VERY painfull proucdure and still in pain...back, hip, leg...next apt is Nov 4th...and untill then I just hope and pray that everyday it gets a bit better...

Hi MPT,

Disks are a funny thing...they don't get blood, they are not made of bone, and there are actually 4 quadrants that make up a disk. Inside these disks is a gel-like substance specifically to cushion our backs when we do anything. A contained hernia is the nucleus trying to get out, but hasn't broken the outer disk wall yet. A rupture is when the hernia ruptures through the outer wall. A tear can be anywhere on a disk and "nowhere near" the nucleus. However, the tear is most likely caused by a herniated disk. The hernia could be "going the other way" from the tear... it is a presure-thing (for lack of a better way to describe it)...lots of stress coming from somewhere.

There are new technological advances with the nucleoplasty. Not only are they for contained herniated disks, but also for tears. My disk height was almost gone on my L5/S1...yet they still did a nucleoplasty on it....how? At the same time they did the nucleoplasty, they also injected back into that disk a man-made gel-like substance to replace the lost stuff and to "plump" my disk back up again. Then they closed it all off neatly with the IDET procedure, which was also done on my L4/L5 (only--along with the intra-discal injections).

They made 8 holes in me (4 on each side). Thank the heavens everything went like text book. No problems at all. I was rated among the top 10% of successful patients at the Spinal Diagnostics Center. But it was a LOT of hard work. And still is. I wasn't walking before surgery...and am walking just fine now.

Confidence in the procedure you choose as well as the surgeon who will be performing it are what you need to work on right now. Gather as much knowledge as you can. These boards are wonderful for the human aspect, the medical websites are wonderful for the medical "terminology" aspect. What is your healing history, your families healing history? They all come in to play here.

The nucleoplasty is the least invasive of the "non-invasive" procedures. The microdisectomy puts undo stress on your back muscles and you are being cut into. The endoscopic microdiskectomy is your best bet for herniations that have ruptured through. They have a special tool that goes through the muscles (instead of spreading them apart to get to the disk). Recovery times for this procedure are half that of the "regular" discectomies (at least that is what is purported)...truth told, it is a bit less than that, but is STILL better.

I hope this helps. Good luck to you!


------------------
successtory
Oct 2000: Repetitive Stress Injury-Inverted Hernia
Feb 2001: MRI. Shows only slight bulge at L4-L5
Dec 2001: Discogram/CT scan shows Inverted Hernia at L5-S1. L4-L5 & L5-S1 ruptured in all 4 quadrants. Unable to walk.
Feb 2002: IDET, Nucleoplasty, Intra-Discal Injections
Sept 2002: Rated in the top 10% for successful patients. Retraining for new career.

Thank you both for replying.
Jus- What is your specific diagnosis? It seems from what others are saying, that you have to be patient and give it time. I think with this procedure, the rehab. and sticking to the restrictions is key. Hang in there. I wouldn't rush into major disc replacement surgery. Usually, this is your last resort. Have they ever recommended microdisectomy for you? I think this might be your next option if the nucleoplasty doesn't work. Be positive and good luck to you.
MPT
Successory-
thank for all that good information. I have a few questions for you. Did a Dr. Chen perform the procedure on you? I had an article that he wrote re: nucleoplasty. I tried to contact him at Stanford but they told me he was no longer there and wouldn't tell me where he went. I finally found him and am waiting for a response from my email to him. Is he the first doctor to perform the procedure in the US?
I went to a top spine surgeon in NY (Dr. Frank Cammisa). He does both the nucleoplasty and the microdiscectomy. He told me that he thinks that my disc is too large and that I wouldn't get a good result with the nucleoplasty. He thinks from the MRI that I have a tear on the inner portion of the annulus but that it has not broken through completely (as you put it ruptured). He feels that the best solution is the microdiscectomy, even the though the disc is contained.
Do you know what that man-made jelly is called or if the procedure has a particular name? I am concerned about the microdiscectomy because they are going to take a piece out of the disc (which will leave a hole in it as well as a hole in the lamina of the verebrae) which I feel will speed up the degenerative process. The comment from the doctor was that degeneration has already started and will continue anyway. I am really beating myself up about this. It is such a hard decision to make whether to go with one or the other. I am afraid that if I wait too long, I will get worse and get permanent nerve damage. Right now I don't have nerve damage in my right leg. But then again, the disc could dehydrate and shrink and then I would be better without surgery. I guess the issue is how long do I wait to do anything.
Thank you so much for listening. I am glad you got help and it went in your favor.
MPT

successtory-

i would like to know more about this gel stuff to.
my doc has a doc friend at ucla med cntr who has found a combo of medicine that helps to heal disk tears from the inside out. it is done during the nucleo instead of adding idet.
it contains chondroitin, glucosamine, dextrose, and one more i forgot. they used it for me to help a small annular tear.
time will tell.

ken

MPT, well after almost 3 weeks I am still getting very sharp pains in my left butt cheek...which slowly moves down the leg...and also still the feeling of shifting in the spine...My disk was torn in both the front and back with leaking..when we did the diskogram you were able to see the die spill out of the disk into the surrounding areas...with the Nucleoplasty I was told I had a 50/50 chance it would work since the disk was so far gone...well I have my follow up next week and I will let you knw how it goes and my docs. recomendation...as for your decision...I find when you go with your gut...it tends to be the right choice...

successtory -

thats the same mix my doc gave me !

- ken

well..it was conf. that the Nucleoplasty did not work...and now my doc. would like to do more tests...ugh...more needles but now he wants to go lower then S1...I am so frustrated....but he is concerned that with all my pain he may be missing something...but I've got to tell you...just getting the guts to get back on that table is a very hard thing...I wouldn't mind so much if I weren't so sensitive to the pain of the injections and the fear of hitting a nerve...which has happened each time...well I hope to know more next week...cheers

well..it was conf. that the Nucleoplasty did not work...and now my doc. would like to do more tests...ugh...more needles but now he wants to go lower then S1...I am so frustrated....but he is concerned that with all my pain he may be missing something...but I've got to tell you...just getting the guts to get back on that table is a very hard thing...I wouldn't mind so much if I weren't so sensitive to the pain of the injections and the fear of hitting a nerve...which has happened each time...well I hope to know more next week...cheers
Jus-
So sorry that you are going through this. Why is the doc so sure that the nucleoplasty didn't work? I heard that after the procedure, you should not have any procedures done until four months. this is what the doctor told me that does the procedure. It is at that time that you will know either way if it helped. You should tell this to Successory (maybe she has read this already). I am sure that she will agree that you should wait before getting on the table again. This even means an injection. I wouldn't let your doc do anything for a few months. It is in the literature. Be well and have faith. I don't know if you are a little religious but do some praying. I can't explain it but I have, in some way, got some answer as to what to do.
Alicia (MPT)