Nucleoplasty

 

When Is a Nucleoplasty Recommended for Spine Pain?

Back and neck pain related to disc problems is a common concern, with a considerable number of patients seeking medical care for conditions such as herniated or bulging discs. For some, persistent pain affects daily activities and quality of life despite medication, physiotherapy or other conservative measures. In these cases, minimally invasive procedures such as nucleoplasty may be considered.

What Is Nucleoplasty and How Does It Work?

Nucleoplasty, also known as percutaneous disc decompression, is a minimally invasive procedure designed to treat pain caused by bulging or herniated spinal discs. By removing small amounts of disc material from the centre of the disc, the procedure reduces internal pressure and allows the bulging disc to retract away from compressed nerves.

The procedure takes about 20 to 60 minutes and is typically performed on an outpatient basis. Using fluoroscopic (real-time X-ray) guidance, the doctor carefully inserts a thin needle through the skin into the affected disc. A specialised probe is then passed through the needle to precisely remove tissue in a controlled manner. The entire process is done under local anaesthesia with light sedation, keeping you comfortable and alert enough to provide feedback to ensure accurate targeting.

Types of Spine Disc Problems That May Qualify

Not all disc problems are suitable for nucleoplasty treatment. The procedure is most effective for specific types of disc conditions where the disc structure remains largely intact.

• Bulging or Protruding Discs

Bulging discs occur when the disc's outer wall remains intact but protrudes outward, potentially pressing against nerve roots. This "contained" herniation is ideal for nucleoplasty treatment because reducing the disc's internal volume can allow the bulge to retract naturally.

• Mild to Moderate Herniations without Sequestration

Nucleoplasty is effective for mild to moderate disc herniations, provided the herniated material is still connected to the main disc. If a sequestered fragment has broken off and migrated into the spinal canal, nucleoplasty cannot remove it, as the procedure only works within the disc itself. MRI imaging is essential to confirm that the disc material has not moved out of place.

• Disc Degeneration Without Severe Loss of Disc Height

When a disc has moderate degeneration but maintains sufficient height, nucleoplasty can help by lowering internal pressure. However, if the disc has severely collapsed, its structural integrity is compromised, and other treatment options may be more suitable.

Is Nucleoplasty the Right Step for Your Spine Pain?

Nucleoplasty may offer relief for patients, but it is not suitable for all cases, particularly where severe neurological symptoms, spinal instability or sequestered disc fragments are present. 

Proper patient selection is essential for successful nucleoplasty outcomes. Before considering this procedure, you should have already tried conservative treatments such as rest, physiotherapy, anti-inflammatory medications and possibly epidural steroid injections.

• Severity & Duration of Pain: Pain should be significant enough to interfere with daily activities and must have persisted for at least 6 weeks to 3 months despite conservative care.

• Clear Imaging Findings: MRI results must show a contained disc herniation that matches your symptoms. The disc should bulge or herniate without sequestration or migration, have preserved height and no severe spinal stenosis.

• Single Affected Disc: Nucleoplasty works best when treating one symptomatic disc level, as this provides clearer results and reduces procedural complexity.

• No Severe Neurological Issues or Spinal Instability: Patients should not have severe weakness, numbness, bowel or bladder dysfunction, or spinal instability such as spondylolisthesis, as these require alternative treatments.

Consult a Pain Specialist in Singapore About Nucleoplasty

If you are struggling with debilitating back or neck pain, it is important to consult a qualified pain specialist to explore treatment options. Procedures like nucleoplasty offer a minimally invasive solution for patients who have not found relief through conservative methods.

Dr Thor Timothy, an experienced consultant pain specialist and anaesthesiologist in Singapore, provides expert care at Novena Pain Management Centre, with clinics at Mount Elizabeth Novena Hospital and Farrer Park Hospital. With over 20 years of clinical experience, Dr Thor is recognised for his patient-first philosophy and holistic, evidence-based approach, focusing on effective, non-surgical treatments for lasting relief.

Credentials & Expertise

• MBBS (Singapore) and Master of Medicine (Anaesthesiology)

• Fellow, Faculty of Pain Medicine (Australia & New Zealand College of Anaesthetists)

• Fellow, Interventional Pain Practice (USA)

• European Diploma in Pain Medicine

• Fellow, Academy of Medicine, Singapore

With his extensive experience, Dr Thor offers personalised, minimally invasive care, helping patients manage pain effectively and return to a better quality of life. You may visit https://www.thepainspecialist.sg/ to learn more about his services and book a consultation.