Have you been dealing with a persistent ache in your lower back or a stiff neck that just won’t ease, even after days of rest, stretching or physiotherapy? What starts as a minor discomfort can gradually interfere with your daily life, making simple activities like bending, lifting or sitting for long periods frustrating.
For some patients, nucleoplasty offers a minimally invasive solution that targets the source of disc-related pain while avoiding the recovery time and risks associated with open surgery. In this article, we look at when nucleoplasty is recommended, how it works and what to expect from the procedure.
What Is Nucleoplasty and Is it Effective for Back Pain?
Nucleoplasty is a minimally invasive procedure used to treat mild to moderate herniated or bulging spinal discs that cause disc-related lower back pain or neck pain, often with associated nerve irritation. It is typically performed under local anaesthesia, allowing patients to return home on the same day.
For selected patients, nucleoplasty can be effective in reducing pain when symptoms are caused by increased disc pressure or a contained disc herniation rather than muscular strain alone. By reducing internal disc pressure, the procedure may help ease nerve irritation and improve function over time.
During the procedure, a thin needle is guided into the affected disc under X-ray imaging. Controlled radiofrequency or plasma energy is applied to ablate a small amount of disc tissue, lowering disc pressure and relieving irritation of nearby nerves.
Nucleoplasty may be considered when disc-related symptoms persist despite non-surgical treatments such as medication or physiotherapy. It is most suitable when:
- Imaging studies, such as MRI, show a mild to moderate disc herniation that has not ruptured
- Pain continues for more than six weeks despite conservative care
- Symptoms include pain radiating to the arms or legs due to nerve compression
- There are no severe or progressive neurological deficits that require traditional open surgery
Who May Not Be Suitable for Nucleoplasty?
While nucleoplasty can help selected patients, it is not suitable for all types of disc-related pain. Careful assessment is essential to ensure safe, appropriate outcomes. The procedure may not be recommended in the following situations:
- Severe or Advanced Disc Degeneration: If a disc has collapsed significantly, with more than 50% loss of height or bone-on-bone contact, nucleoplasty is unlikely to provide meaningful relief.
- Spinal Instability: Patients with abnormal spinal movement usually need more extensive surgical stabilisation rather than disc decompression alone.
- Large or Sequestered Disc Herniation: When disc material has broken off and moved into the spinal canal, nucleoplasty cannot remove it effectively.
- Progressive Neurological Symptoms: Worsening weakness, loss of bladder or bowel control indicates severe nerve compression that often requires urgent surgery.
- Infections or Tumours: The procedure is unsafe if spinal infections or tumours are present, as it could aggravate the condition or cause complications.
A thorough evaluation, including imaging and consultation with a spine specialist, is necessary to determine whether nucleoplasty is an appropriate treatment option.
What to Expect During and After the Procedure
Nucleoplasty is usually performed as a day procedure in a sterile medical setting, allowing most patients to return home the same day.
During the Procedure
The procedure is usually carried out under local anaesthesia with light sedation, keeping you comfortable while remaining awake. You will lie face down on the procedure table, and the targeted area of your spine, most often the lower back, will be thoroughly cleaned and sterilised.
Using X-ray or fluoroscopic guidance, the physician carefully inserts a fine needle into the affected disc. A specialised probe is then passed through the needle into the centre of the disc. Controlled radiofrequency or plasma energy is applied to remove a small portion of disc material, reducing internal pressure and relieving irritation of nearby nerves. Once the decompression is complete, the probe and needle are removed, and a small dressing is applied over the puncture site.
After the Procedure
Following nucleoplasty, you will be monitored in a recovery area for one to two hours before being discharged. Mild soreness around the treatment site is common and usually resolves within a few days. Pain relief and improvements in mobility generally develop gradually over two to six weeks as the disc heals and nerve irritation decreases.
What Are the Benefits of Nucleoplasty?
Nucleoplasty offers selected patients meaningful pain relief without the longer recovery associated with more invasive procedures. Key benefits include:
- Minimally Invasive: The procedure is performed through a small needle puncture, causing less disruption to surrounding tissues compared to open surgery.
- Faster Recovery: Most patients can resume light activities within a few days to a week, with minimal downtime.
- Minimal Scarring: No large incisions are required, so visible scarring is minimal or absent.
- Effective Pain Relief: By reducing pressure within the disc, nucleoplasty relieves nerve compression, gradually easing pain and discomfort.
- Lower Risk of Complications: Compared with traditional surgery, the risks of major bleeding, infection or nerve injury are generally lower.
Potential Risks and Complications of Nucleoplasty
As with any medical procedure, nucleoplasty carries some risks, although complications are uncommon when it is performed by an experienced pain or spine specialist. Your doctor will explain these risks in detail and take appropriate precautions before, during and after the procedure to prioritise your safety.
Possible risks include:
- Infection: Infection may occur at the needle entry site or, rarely, within the disc itself, a condition known as discitis.
- Nerve Irritation or Injury: There is a small risk of irritation to nearby spinal nerves, which may cause temporary numbness, tingling or discomfort.
- Temporary Increase in Pain: Some patients experience a short-term flare-up of back or leg pain after the procedure, which usually settles as healing progresses.
- Bleeding or Haematoma: Minor bleeding around the treated area can occur, though significant bleeding is uncommon.
Discover the Best Approach for Your Spine Pain
Persistent back or neck pain doesn’t have to control your life. For selected patients with disc-related symptoms, nucleoplasty offers a minimally invasive option that may relieve pain without the longer recovery of open surgery. A careful assessment by a spine specialist helps ensure that any treatment chosen is appropriate, safe and aligned with your needs.
Dr Thor Timothy takes a thoughtful, evidence-based approach to pain management, focusing on accurate diagnosis and minimally invasive solutions where appropriate. If you are considering nucleoplasty, schedule a consultation with Dr Thor to find out whether nucleoplasty is suitable for your condition and to discuss a personalised plan to improve comfort and function.
