With pain in the spine, many relate to the phenomenon quite nonchalantly, considering this a result of overload and stress. During this time, an intervertebral hernia often develops, in which the disk is affected.
Depending on the degree of damage, the hernia is simple or sequestered. It will not work out here already, and excruciating pains begin not only in the spine, but also in the legs.
What is an intervertebral hernia
The intervertebral disc is a cartilage pad between the vertebral bodies, which takes on the role of a shock absorber or spring during physical exertion. It is a fibrous elastic ring, inside of which there is a pulp - a gelatinous or jelly-like substance of the nucleus.
With age or with the wrong lifestyle, the disk tends to wear out, the elasticity of the ring is lost. It can become squeezed, flattened, have microcracks, the pressure inside it rises. The jelly-like nucleus (pulp) protrudes into the intervertebral space, the disc protrudes into the longitudinal ligament. This is a herniated disc.
A protrusion almost always leads to compression of the spinal cord or spinal roots. Then there are severe syndromes, incontinence of feces, urine and even paralysis of the legs.
Spinal hernia treatment
There is no etiotropic, that is, causal, treatment for cartilage degeneration of the disc. All conservative methods are symptomatic and pathogenetic effects. This means only temporary relief from pain, muscle spasm, swelling and inflammation at the site of infringement of the roots.
What is nucleoplasty?
Since the middle of the 20th century. operations on the intervertebral discs began - diskectomy, laminectomy. They belong to the category of complex ones, they do not always give an effect and require a long rehabilitation.
Moreover, they disrupt the biomechanics of the spine, because the pressure on the adjacent discs increases, and a hernia can form in another part of the spine.
Later, mini-operations (minimally invasive) began - mini-discectomy, endoscopic disc removal, percutaneous discectomy (nucleoplasty).
Nucleoplasty is a whole group of minimally invasive procedures in which the effect is directly on the disk core. With it, with minimal injuries, part of the pulp of the nucleus of the disk is removed (in Latin, nucleus is “core”, plastika is “change”).
Most often, cold plasma is used from nucleoplasty. The word "cold plasma" means that plastic is produced using cold plasma.
This procedure is also called coblation (this is a combination of 2 English words - cold and ablation, which means "destruction by cold"). The method was developed by American scientists Hira Tapliyal and Phil Eggers back in 1980 and has received the widest application worldwide.
The essence of the method
The essence of the innovation lies in the fact that a puncture needle is inserted percutaneously into the disk. When summing up the electrodes, radio-frequency waves, laser energy, or a cloud of cold plasma can be generated at its end. They all destroy the pulp of the nucleus and the so-called. the effect of reverse pulling the displaced pulp into the frames of the disk ring. The vertebra is leveled, the nerve roots are released, and the pain disappears. The entire operation is carried out under the control of an x-ray unit.
Only the nucleus is removed, while the fibrous ring surrounding it is intact. It is pulled back between the vertebrae due to its elasticity. A tissue burn does not occur.
Types of Nucleoplasty
In addition to cold plasma, there are also:
- Radiofrequency ablation - electromagnetic waves act on the core.
- Hydroplasty - a saline stream under pressure with subsequent aspiration of the residues.
- Interventional discotomy - the destruction of the nucleus occurs mechanically by a miniature device having a rotating head and acting like a mixer.
- Laser vaporization is the transformation of the substance of a nucleus into a vapor by a beam.
Benefits of Nucleoplasty
The benefits include the following:
- Anesthesia is not required, local anesthesia is enough.
- There is no prolonged hospitalization, the patient is discharged home after surgery after 3-4 hours. Postoperative biomechanics of the column is not disturbed, since the disk itself is not removed.
- It is possible to treat several disks at once in 1 operation.
- No blood loss.
- The rarity of complications.
- It can be performed with contraindications for major surgery.
- There are no incisions, scars and adhesions, and as a result, the spinal cord is not compressed.
- Nerve roots are not damaged, since the patient can inform the surgeon about all pain during the operation.
- The surrounding tissue does not get burned.
- The duration of the intervention is about half an hour.
- The performance indicator is 80%.
Indications for nucleoplasty
The operation may not be useful to everyone. Cold plasma nucleoplasty has its own indications:
- Disc protrusion and intervertebral hernia confirmed by MRI.
- Pain in the area of the affected disc, when pain is given to the legs.
- There is no result from conservative treatment for 3 months.
Contraindications to nucleoplasty
Contraindications include:
- Violation of the integrity of the fibrous ring - there is no point in nucleoplasty.
- Sequestered herniated disc, i.e., its division into fragments.
- The disk occupies more than 30% of the diameter of the spinal canal.
- Disc height is more than halved.
- Spinal cord tumor.
- Narrowing of the spinal canal.
- Displacement and instability of the vertebrae (spondylolisthesis).
- The infection is both local and general.
- Decompensation of chronic diseases.
- Damage to the spinal roots.
- The increase in compression of the spinal cord (then the operation is only open).
- Increased bleeding.
Nucleoplasty preparation
The selection of patients for surgery is carried out strictly according to indications. The surgeon should have a very clear idea of the condition of the vertebrae, the location and size of the hernia of the disc, the condition of the fibrous ring, spinal canal and spinal cord. The answer to all this can give an MRI study. Therefore, without it, surgery is not performed. A routine examination remains mandatory.
How is the operation of nucleoplasty
8-10 hours before surgery, you can not eat and drink. In the evening, a cleansing enema is done. An antibiotic (1 million units of "Cefazolin") is prophylactically administered once per hour of operation. For additional analgesia and sedation, 2 ml of Diazepam is administered before surgery. Local anesthesia is usually done, but if necessary, epidural or general anesthesia is not excluded.
Surgical intervention is carried out in x-ray. The patient lies on a table, on his stomach or on his side with legs pressed to his stomach (with lumbar hernia localization).
If the patient is not sure that he will be able to lie still for 15-20 minutes, intravenous anesthesia is done. The surgical field is lubricated with antiseptics and infiltrated with novocaine or lidocaine.
Under the control of an intraoperative X-ray unit, a needle is inserted where the fibrosis of the ring passes into the jelly of the nucleus. Then, the corresponding electrode is brought through the needle cannula and the pulp nucleus is destroyed.
By rotational-translational movements of the electrode, the surgeon melts the substance of the nucleus in different directions. There is no pain. The intervention lasts 15-30 minutes. Then, after removing the electrode and the needle itself, the puncture site is treated with an antiseptic and sealed with a plaster.
After operation
2 hours after the procedure, you are allowed to get up. The patient can be discharged in the absence of complications and the presence of their own transport. The operation is less traumatic, and a person will be able to return to normal life soon.
Possible complications
Complications are observed quite rarely - only 0.1%. Among them:
- spondylodiscitis - inflammation of the disk of any etiology;
- damage to the nerve root, if they last more than 2 weeks (within this period they are not considered a complication, as they are for everyone);
- accidental damage to an artery in the neck - during surgery in the cervical region or hematoma in the lumbar muscles.
In 20% of cases, nucleoplasty does not give an effect. The main reasons for this result:
- initially not taken into account the size of the hernia, the violation of the integrity of the ring;
- pathology is not associated with a hernia;
- plastic was performed only on 1 disc, and there were several damages;
- the patient’s age is not taken into account - after 55 years of age, the fibrous ring has low elasticity and cannot be drawn between the vertebrae.
Features of the rehabilitation period
Within 2 weeks after lumbar cold plasma nucleoplasty, immobilization of the spine by wearing a corset or cervical collar, limiting physical activity is recommended. The effect after surgery often appears immediately, but basically the improvement occurs within 1-2 months.
In most cases, in the first 2 weeks after cold plasma nucleoplasty of the intervertebral discs in the back and legs, the pains are intensified. This does not indicate an incorrect procedure, but is explained by the fact that the disappearance of intervertebral compression is slow.
The first conclusions can be made only after 16 days, when the patient after surgery must come for a neurosurgeon examination and x-ray control. The final analysis of the effectiveness of treatment is carried out 1-2 months after surgery.
In the first month, physical activity, sports, even sitting behind the wheel, any inclinations are completely excluded. You can sit in the first month only for 2 hours, gradually increase the time.
Also, in the first 2 months after cold plasma nucleoplasty, it is necessary to take NSAIDs to reduce pain and the inflammatory reaction: Nimesulide, Ibuprofen, Indomethacin, Meloxicam, Ketanov, Diclofenac. Coxib preparations may also be prescribed: Celebrex, Rofecoxib, etc.
Within a month after cold-plasma disk nucleoplasty, thermal procedures on the spine are excluded:
- balneotherapy;
- massage;
- electrophoresis.
But laser and magnetotherapy for the spine are favorable.
Perspective changes
Special rehabilitation is not required.
In the future, excess body weight should be normalized, nutrition and daily regimen should be adjusted. Swimming is very useful - an hour 2 times a week. Neck twist styles are undesirable.
With problems in the cervical spine it is better to swim on the back. Daily gymnastics, which will strengthen the muscle corset, is also useful.
Cost of treatment
Cold plasma nucleoplasty of intervertebral discs is performed in many countries; it is quite expensive. The only difference is that in Europe and Israel it has been implemented for more than 15 years and has been completely honed.
The best in this regard are the Czech Republic (the leader), Israel, Germany, and the USA.
In Israel, the procedure costs about 17-20 thousand dollars (1.2-1.4 million rubles). In Russia, the minus is that such interventions began only in 2011 in Moscow. Later they began to operate in large regional centers and metropolitan clinics.
Cold plasma nucleoplasty in Moscow will cost about the following amount:
- cervical spine (1 element) - from 67 thousand rubles. and higher;
- lumbar - 35-67 thousand rubles;
- neurosurgeon consultation - 4-5 thousand rubles;
- preoperative diagnostics - from 6 thousand rubles;
- hospital stay 1 day - from 5 thousand rubles.
The cost depends on the qualifications of the surgeon, the category of the clinic and equipment. The result is from 100 to 120 thousand, and in some countries up to 750 thousand rubles.
Reviews
In the vast majority of cases, reviews of cold plasma nucleoplasty of the intervertebral discs are positive. Many regret that they delayed the operation and did not do it right away. The price is high, but it pays off. The cost of the operation is not more than the cost of conservative treatment (inconclusive) for several years.
Many reviews of cold plasma nucleoplasty indicate that patients have to consent to surgery due to severe pain in the back and legs, but the results exceed all costs. During the operation, nothing was felt, and in the evening he was already at home. Soon you can return to work.
Reviews of cold plasma nucleoplasty of the intervertebral discs indicate that the operation is almost painless. After surgery, pain can go away for many immediately or gradually over the course of a month.
Reviews of the effectiveness of cold plasma nucleoplasty indicate inconclusive drug treatment with conservative methods.
Patients who underwent surgery write that nucleoplasty is expensive, but in most cases it’s worth it, everything goes completely, and recovery comes.
Very few reviews of cold plasma nucleoplasty disk with no effect. The advantage is that there are practically no restrictions after surgery and no sick leave is needed.
Reviews of cold plasma nucleoplasty on hernia are positive especially in such impressive moments when patients suffered from the problem for more than 10 years.
Some Nucleoplasty Information
Such operations on a global scale are carried out by tens of thousands. However, microinvasive intervention “works” only with mild protrusions - not more than 6 mm.
With large hernias, there is no effect. The advantage of the cold method is that there is no burn of surrounding tissues. This explains the demand for the method.
Everything else - duration, technique, anesthesia and rehabilitation after any type of nucleoplasty performed - is similar. But you should know that even with a successful operation, there is no guarantee for a lasting effect. Postoperative relapses occur in everyone, but at different times - most often after 1-3 years. That is, there is no complete liberation from pathology. Again, there is a need to repeat the session or to completely remove the disk.