With pain in the spine, many are rather careless about the phenomenon, considering it the result of overload and tension. During this time, an intervertebral hernia often has time to form, in which the disc is affected.
Depending on the degree of damage, the hernia is simple or sequestered. Here it is already impossible to brush aside, and excruciating pains begin not only in the spine, but also in the legs.
What is a herniated disc
The intervertebral disc is a cartilaginous lining 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 substancekernels.
With age or with the wrong lifestyle, the disc tends to wear out, the elasticity of the ring is lost. It can become compressed, 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.
Protrusion almost always leads to compression of the spinal cord or spinal roots. Then the strongest syndromes appear, incontinence of feces, urine and even paralysis of the legs.
Treatment of spinal hernias
There is no etiotropic, that is, causal, treatment for disc cartilage degeneration. 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
From the middle of the 20th c. operations on intervertebral discs began to be used - discectomy, laminectomy. They are classified as complex, the effect is not always given and require long-term rehabilitation.
Moreover, they disrupt the biomechanics of the spine, because the pressure on the neighboring discs increases, and a hernia can form in another part of the spine.
Later, mini-surgeries (minimally invasive) began to be performed - mini-discectomy, endoscopic disc removal, percutaneous discectomy (nucleoplasty).
Nucleoplasty is a whole group of minimally invasive procedures in which the impact isdirectly to the disk core. With it, with minimal trauma, a part of the pulp of the disc nucleus is removed (in Latin, nucleus is “core”, plastika is “change”).
Cold-plasma nucleoplasty is used more often than others. 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 is widely used worldwide.
The essence of the method
The essence of the innovation lies in the fact that a puncture needle is inserted percutaneously into the disc. When the electrodes are placed at its end, radio frequency waves, laser energy, or a cloud of cold plasma can be generated. They all destroy the pulp of the nucleus and the so-called. the effect of retraction of the displaced pulp into the frames of the disc annulus. The vertebra is aligned, the nerve roots are released, and the pain disappears. The whole operation is carried out under the control of the X-ray unit.
Only the nucleus is removed, the fibrous ring surrounding it is intact. It is pulled back between the vertebrae due to its elasticity. In this case, tissue burns do not occur.
Types of nucleoplasty
In addition to cold plasma, there is also:
- Radiofrequency ablation - Electromagnetic waves are applied to the nucleus.
- Hydroplasty - a jet of saline under pressure, followed by aspiration of residues.
- Interventional discotomy - destruction of the nucleustakes place mechanically with a miniature device that has a rotating head and acts like a mixer.
- Laser vaporization - the transformation of the substance of the core into steam by a beam.
Nucleoplasty Benefits
Benefits include:
- No anesthesia required, local anesthetic is sufficient.
- No long-term hospitalization, the patient is discharged home after surgery after 3-4 hours. The postoperative biomechanics of the post is not disturbed as the disc itself is not removed.
- It is possible to treat several disks at once in one operation.
- No blood loss.
- Rarity of complications.
- May be performed if major surgery is contraindicated.
- There are no incisions, scars or adhesions, and as a result, the spinal cord is not compressed.
- Nerve roots are not damaged, since the patient can report all pain to the surgeon during the operation.
- Surrounding tissues are not burned.
- The duration of the intervention is about half an hour.
- Efficiency rate is 80%.
Indications for nucleoplasty
The operation may not be beneficial to everyone. There are indications for cold plasma nucleoplasty:
- Disc protrusion and disc herniation confirmed by MRI.
- Pain syndrome in the area of the affected disc, when the pain is given to the legs.
- No result from conservative treatment within 3 months.
Contraindications for nucleoplasty
Contraindications include:
- Violation of the integrity of the fibrous ring - there is no point in nucleoplasty.
- Sequestered disc herniation, i.e. its division into fragments.
- The disc occupies more than 30% of the diameter of the spinal canal.
- Disk height more than halved.
- Tumor of the spinal cord.
- Narrowing of the spinal canal.
- Displacement and instability of the vertebrae (spondylolisthesis).
- Infection, both local and general.
- Decompensation of chronic diseases.
- Injury to the spinal roots.
- Increase in compression of the spinal cord (operation then only open).
- Increased bleeding.
Preparation for nucleoplasty
Selection of patients for surgery is carried out strictly according to indications. The surgeon should have a very clear idea of the state of the vertebrae, the location and size of the disc herniation, the condition of the annulus fibrosus, spinal canal and spinal cord. The answer to all this can give an MRI study. Therefore, without it, the operation is not carried out. Standard examination remains mandatory.
How a nucleoplasty is performed
For 8-10 hours before the operation you can not eat or drink. In the evening, a cleansing enema is done. An antibiotic (1 million units of Cefazolin) is administered once per hour of the operation. For additional pain relief and sedation, 2 ml is administered before surgery"Diazepam". Local anesthesia is usually given, but epidural or general anesthesia is possible if necessary.
Surgical intervention is carried out in the X-ray operating room. The patient lies on the table, on his stomach or on his side with his legs pressed to his stomach (with lumbar localization of the hernia).
If the patient is not sure that he can lie still for 15-20 minutes, intravenous anesthesia is done. The operating field is smeared with antiseptics and infiltrated with novocaine or lidocaine.
Under the control of the intraoperative X-ray unit, a needle is inserted where the fibrosis of the annulus passes into the jelly of the nucleus. Then, through the cannula of the needle, the appropriate electrode is brought in and the procedure for the destruction of the nucleus pulposus is carried out.
Rotational-translational movements of the electrode, the surgeon melts the substance of the nucleus in different directions. There is no pain in this. 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 surgery
Already 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 the person will be able to return to normal life soon.
Possible Complications
Complications are quite rare - only 0.1%. Among them:
- spondylodiscitis - inflammation of the disc of any etiology;
- nerve root damage if it lasts more than 2 weeks (within thisterm, they are not considered a complication, since they happen to everyone);
- accidental damage to the artery in the neck - during surgery in the cervical region or a hematoma in the lumbar muscles.
In 20% of cases, nucleoplasty has no effect. The main reasons for this result:
- initially, the size of the hernia, violations of the integrity of the ring were not taken into account;
- pathology not related to hernia;
- plastic surgery was carried out only on 1 disc, and there were several damages;
- the age of the patient is not taken into account - after 55 years, the fibrous ring has low elasticity, and it cannot retract 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 in general, 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 pain is intensified. This does not indicate the incorrectness of the procedure, but is due to the fact that the disappearance of intervertebral compression is slow.
First conclusions can be made only after 16 days, when the patient after the operation must come for examination by a neurosurgeon and X-ray control. The final analysis of the effectiveness of the treatment is carried out 1-2 months after the operation.
In the first monthphysical activity, sports, even driving, 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 inflammation: Nimesulide, Ibuprofen, Indomethacin, Meloxicam, Ketanov, Diclofenac. Coxibs can also be prescribed: Celebrex, Rofecoxib, etc.
Within a month after cold plasma disc nucleoplasty, thermal procedures on the spine are excluded:
- balneotherapy;
- massage;
- electrophoresis.
But laser and magnetic therapy for the spine are favorable.
Changes in perspective
No special rehabilitation required.
In the future, you should normalize excess body weight, adjust your diet and daily routine. Swimming is very useful - for an hour 2 times a week. Styles with neck turns are undesirable.
With problems in the cervical region, it is better to swim on your back. Also useful is daily gymnastics, which will strengthen the muscular corset.
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 performed for more than 15 years and has been fully honed.
The best in this regard are the Czech Republic (leading), Israel, Germany, USA.
In Israel, the procedure costs about17-20 thousand dollars (1.2-1.4 million rubles). In Russia, the downside is that such interventions began only in 2011 in Moscow. Later, they began to operate in large regional centers and near-capital clinics.
Cold-plasma nucleoplasty in Moscow will cost approximately the following amount:
- cervical (1 element) - from 67 thousand rubles. and above;
- lumbar - 35-67 thousand rubles;
- consultation of a neurosurgeon - 4-5 thousand rubles;
- preoperative diagnostics - from 6 thousand rubles;
- Stay in a hospital for 1 day - from 5 thousand rubles.
The cost depends on the qualifications of the surgeon, the category of the clinic and equipment. As a result, it turns out 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 intervertebral discs are positive. Many regret that they delayed the operation and did not do it right away. The price is high, but it justifies itself. The cost of the operation is no more than the cost of conservative treatment (ineffective) for several years.
Many reviews of cold plasma nucleoplasty talk about the forced consent of patients 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 the person was already at home. You can return to work soon.
Reviews of cold plasma nucleoplasty of intervertebral discs indicate that the operation is almost painless. After surgery, the pain in many people can go away immediately or gradually inwithin a month.
Reviews on the effectiveness of cold plasma nucleoplasty speak of ineffective medical treatment with conservative methods.
Patients who have undergone surgery write that nucleoplasty is expensive, but in most cases it is worth it, everything goes completely, and recovery begins.
Very few reviews of cold plasma disc nucleoplasty with no effect. The advantage is that there are practically no restrictions after the operation and no sick leave is needed.
Reviews of cold plasma nucleoplasty on a hernia are positive, especially in such impressive moments when patients suffered with the problem for more than 10 years.
Some information about nucleoplasty
Such operations on a global scale are carried out by tens of thousands. However, microinvasive intervention “works” only with mild protrusions - no more than 6 mm.
With large hernias, there is no effect. The advantage of the cold method is that there is no burn of the surrounding tissues. This explains the demand for the method.
Everything else - duration, technique, anesthesia and rehabilitation after any type of nucleoplasty - is similar. But you should know that even with a successful operation, there are no guarantees for a long-term 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 completely remove the disk.
