What is nucleoplasty?
Nucleoplasty is a minimally invasive procedure that uses radiofrequency energy to ablate nucleus pulposus tissue in a controlled manner. This leads to a reduction of pressure on compressed nerve roots, decreased intradiscal pressure. A patented coblation  Technology is applied through a Perc-D Spine Wand. Through the wand, one alternates power and voltage for two modes of actions: coblation at 125 V and coagulation at 65 V. Coblation is a non-heat driven process, in which radiofrequency energy is applied to a conductive medium (saline) to generate a highly focused plasma field around the electrode at the tip of the Perc-D Spine Wand



The first report of the clinical efficacy of nucleoplasty was presented at the Florida Pain Society meeting in 2001. This study examined the safety and clinical benefit of the newest method of percutaneous disc decompression. The cohort was followed for 3 months following the procedure and with this group several conclusions were reached that were confirmed in later, published studies with larger groups of patients. No complications were noted from the procedure; improvements in VAS ratings, percentage of symptom relief and percentage of patients with 50% or greater symptom reduction were statistically and clinically significant

Since then around 10 observational studies are reported with latest by Kallás et al from Brasil on more than 390 patients. All studies report fair reduction of leg pain but poor effect on back pain

Systematic review done in 2009 shows insufficient evidence 

IORG Comment: Insufficient data to prove or disprove. But basically this lies in category of intradiscal steroids, ozone and other chemical [chymopapain] method of local treatment of disc disease. They all have questionable efficacy, some patients respond well while others dont, however literature is unclear on how to spot the patients who will have good response. Also the point is whether or not these same patients get better with aggressive conservative management? Patient Selection will be a key to establish the role of these modalities, unfortunately most literature does not focus on it and lacks comparative study.

Our opinion is to go for standard treatment in form of Rest, medicaltions, physiotherapy and if not responding to go for microlumbar discectomy. 

We await more literature from proponents of nucleoplasty to help us recommend the procedure