[Lumbar nucleoplasty]

Low back pain (LBP) is one of the common reasons for people to seek treatment from a physician. A familiar cause of LBP and radicular pain is disc bulge or protrusion. The treatment for this indication is diverse and suited to the type pathology and its severity. The treatment can be conservative ranging from a diversity of minimal invasive surgical methods to an open discectomy. The classification of disc herniation is based on the severity of the bulge, whereby the lowest degree is protrusion/ prolapse, then extrusion and the most severe level is sequestered disc. This classification is important when considering the treatment options. One of the known possible treatments for disc protrusion is Nucleoplasty or disc Coblation. This percutaneous surgical method is used to treat discogenic back pain and radicular pain. This method is based on reducing disc volume by using radio frequency energy. During the last decade, many medical centers worldwide used this procedure. In recent years, this method is rising in popuLarity due to its percutaneous approach, low complication rate, good results at the post surgical stage reflecting improvement in symptoms and facilitating rapid return to normal life. The accepted indications for Nucleoplastia are discogenic radicular pain, contained disc herniation according to an MRI scan with intact annulus fibrosus, insufficient response to conservative treatment and absence of a medical emergency as in the case of Cauda Equina syndrome. Patient selection according to those parameters is very important. Today this surgical method is still controversial. In recent years many studies regarding Nucleoplasty have been published, although more research is necessary in order to evaluate long term results and tailor it to the appropriate patient and pathology.