Dec. 19, 2001 STANFORD, Calif. - Indigestion isn't the only thing that may prevent Americans from enjoying holiday cheer during the next few weeks. According to the American Physical Therapy Association, the holiday season - and the over-eating, traveling and gift lugging that come with it - leads to a substantial jump in the number of people with back and neck pain. A procedure called nucleoplasty being performed at Stanford University Medical Center, however, may offer relief.
"I was in constant pain until I had nucleoplasty," said Giovanni Tempesta, a 52-year-old Bay Area resident and Stanford instructor who had the minimally invasive procedure this summer. "I noticed immediately after my procedure that the pain was gone - it was like night and day."
Tempesta is one of several dozen patients who have been treated by Yung Chen, MD, with the procedure, which uses low thermal energy to relieve pressure in an intervertebral disk. Nucleoplasty was designed to treat herniated disk, a condition in which the soft, gel-like substance found in the center of a disk presses on the spinal nerves, causing pain in the lower back, numbness or weakness in the leg.
Chen uses nucleoplasty to remove problem tissue and apply controlled levels of heat to the affected disk. During the procedure, he mildly sedates his patient and, with the guidance of X-ray images, advances a needle into the disk. He then places a special wand through the needle, releasing radio-frequency energy that heats the area, evaporating the nucleus material inside the disk.
"The goal is to decrease disk pressure so it doesn't pinch the nerve and so the pain is taken away," said Chen, director of the Stanford Interventional Spine Center and an assistant professor of functional restoration.
Chen said lower back pain is one of the most common ailments affecting adults; as many as four out of five Americans experience significant back problems during their lives. He said back pain is the second most common reason for doctor visits, and herniated disk is the culprit for many. He added that the condition can be caused by such thing as trauma, strenuous activity, genetics and age.
"Everyone gets disk degeneration eventually," said Chen. "It's part of the normal aging process - like people getting wrinkles on their faces."
According to the American Association of Neurological Surgeons, 90 percent of herniated disks can be treated with conservative therapies such as bed rest, exercise or anti-inflammatory medications. In the past, surgery such as a diskectomy - in which the protruding disk is removed - has been the only option for patients who don't respond to conservative therapies and whose pain affects their everyday lives.
Chen said nucleoplasty has many benefits over more invasive surgery. For one, the procedure is quick and painless. Tempesta agreed. "I looked at my watch when it began at 2:05 and I was out at 3:05," he recalled. Recovery time is also minimal. Nucleoplasty patients aren't required to stay in the hospital - as they would be if they had surgery.
"With nucleoplasty, the patient can go home early and enjoy life," said Chen, adding that his patients have reported a 70 percent post-procedure reduction in pain.
Of the 45 patients who have had the procedure at Stanford thus far, Chen said only one has not shown improvement. Most patients, including Tempesta, have responded favorably within one week of the procedure. Chen noted that none of his nucleoplasty patients experienced complications such as bleeding, infection, or nerve or spinal cord damage.
Chen is quick to point out that nucleoplasty is not for everyone. It can not, for example, help patients with a severely herniated disk, an unstable spine, neurological symptoms or stenosis - a narrowing of the spinal canal. For those patients, Chen said, surgery might be necessary.
"Nucleoplasty doesn't replace surgery," he said. "It is for a highly selective group of people."
The procedure was developed by ArthroCare Corporation and was approved by the Food and Drug Administration in 1999. Chen said studies on the procedure's long-term outcomes are still needed.
Stanford University Medical Center integrates research, medical education and patient care at its three institutions - Stanford University School of Medicine, Stanford Hospital & Clinics and Lucile Packard Children's Hospital.
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