Percutaneous nucleotomy
Percutaneous nucleotomy is a surgery technique used for the reomoval of cervical disc herniations. The percutaneous nucleotomy is a good alternative if complaints cannot be cured due to rest, pain killers and physiotherapy; if the herniation is circumscribed and not too big; if there are no osseous stenoses.
How Does Percutaneous Surgery Proceed?
In most cases, the percutaneous nucleotomy as a new minimally invasive technique can be undergone in local anaesthesia. This modern technique is easy on fine nerve structures, and the mobility of discs remains. Surgery takes place in a state-of-the-art operating room under anaesthesia surveillance. The patient lays comfortably on his back and gets local anaesthetics. Small tubes with increasing diameter are navigated to the disc. Herniations are visualized with the help of specific devices and removed by means of minute instruments, resulting in a decompression of the nerve. In special cases, the core of the disc (nucleus pulposus) is shrinked with the aid of a specific enzyme to reduce the volume and to decrease the intradiscal pressure for the purpose of recovery. In opposite to common surgery, the segment does not have to be stiffened.
The illustration depicts the surgeon´s approach to the disc herniation. The surgeon inserts the tube through the throat tissue without damaging vessels or muscles and then removes the disc herniation.
Illustrations A-C explain the percutaneous nucleotomy. The herniated disc compresses nerve tissue and causes complaints like pain or neurological deficits (A). The disc herniation is gently removed by minute instruments through a small tube (B). As a result, the nerve tissue is no longer compressed but relaxed, and, thus, the complaints decrease.
Altogether, surgery lasts 45 minutes and can be done as an out-patient under certain circumstances. Patients can leave the recovery room walking only 2 hours after surgery. After a thorough examination, patients can go home the following day. Wearing a surgical collar is not necessary. Only in a very few cases, a slight pain killer is additionally needed.
Postsurgical management and rehabilitation percutaneous nucleotomy
One day after surgery, there is a check-up and a discussion with a physiotherapist about individual postsurgical rehabilitation means. Normally, the guided physiotherapy programme can start one week after surgery as well as office work can also be resumed. A return to sports and fitness training is possible 6 weeks after surgery.
Advantages percutaneous nucleotomy
Because local anesthesia is applied during out-patient percutaneous nucleotomy, risks of general anesthesia are obsolete. Often pain vanishes directly after surgery. Since percutaneous nucleotomy only necessitates the resection of a small amount of tissue without any means of stabilization like screws or rods, it is easy on muscles and tissue and adjoining discs are not strained. For more than 90% of the patients, stiffening / stabilization surgery can be avoided and, thus, the natural stability of the spine remains. In contrast to open surgery, percutaneous nucleotomy in easy on fine nerve structures. Here you can find the advantages of percutaneous nucleotomy in an overview:
• Local anaesthesia – all risks of general anaesthesia are obsolete
• Surgery is possible as an out-patient
• As a rule, pain vanishes directly after surgery
• More than 90% of the patients can avoid a stiffening operation, and adjoining discs are not additionally strained
• In contrast to open surgery, percutaneous nucleotomy is easy on fine nerve structures
• Good stability remains due to the removal of a very small amount of tissue