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Golfer's Corner |
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 Cervical Prolapsed Disc |
Hernia in the neck Hernia / slipped disc in the cervical spine.
Percutaneous nucleotomyWhen is treatment necessary?
Patients with a cervical hernia report of pain in their neck-area, which often radiates into the shoulder and arm. This pain, in the majority of the cases, is accompanied by a loss of sensation, tingling or loss of movement in the arm and hand. |
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MRT of a herniated disc |
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If this ailments are persistent after a 2 week period of rest, intake of medication and physiotherapy, a percutaneous nucleotomy could mean a significant alternative to conventional, open surgery. The mobility of the vertebral bodies is conserved by means of this delicate technique. Furthermore, the fine nerve-structures are spared and even massive hernias or cases with a stenosis can be treated endoscopically. A hernia of the cervical spine is usually verified by magnetic resonance images. |
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What does the treatment consist of?
The percutaneous nucleotomy is a new, minimally invasive technique which, in most cases, can be performed on an outpatient basis under a safe, local anaesthesia. Invented by Dr. Bonati (USA), this technique has been modified and improved by Dr. Hoogland during the past years.
The treatment is performed in a sterile, most up-to-date operating-room with anaesthetics stand-by. The patient is comfortably located on his back and is treated with local anaesthesia. Small cannulas with increasing diameters are conducted up till where the hernia is located. The hernia is then visualized with a special “spinescope” and removed by means of small instruments, thus freeing the impinched nerve. In some cases, an enzyme is used to shrink the nucleus (core of the disc)in order to release pressure of the protective annulus for the subsequent healing process. In contrast to conventional operations of cervical spine hernias, there is no need for a fusion of the vertebral bodies. The treatment takes only about 45 minutes and patients can leave the clinic just 2 hours after the operation. A postoperative neck collar is not necessary. |
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Reduction of the hernia by means of an enzyme |
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Secession and suction of the affected area. |
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Which post-operative care and rehabilitation is required?
As a rule, the pain has usually disappeared immediately after the percutaneous nucleotomy and the patients are able to return home one day after treatment. Very seldom patients take a painkiller. The next morming an examination by a physician takes place and the patient is advised by a physiotherapist about the proper post-operative behaviour. Physiotherapy usually begins one week after the operation, and at the same time light office work can be taken up. A normal work and exercise routine can be resumed after six weeks at the latest.
What is the success rate?
Data of all patients operated at our center is obtained via questionnaires and analysed statistically. More than 1.100 cervical spine treatments were conducted at the Dr. Hoogland Spine Center since 1991. 90% of patients reported good and excellent results and only one significant complication has been observed to date. The technique has since been altered and new instrumentation has been adapted. The risk of a recurrent cervical hernia is very small.
What are the advantages of the percutaneous nucleotomy compared to an open operation?
- The percutaneous nucleotomy is a save and yet effective treatment of cervical disc herniations
- Bracing or a fusion-operation can be avoided for more than 90% of the affected patients
- Only a very small amount of tissue has to be removed, thus maintaining a good stability
- Fine nerve-structures are spared, contrary to the invasive, open procedure
- Adjacent levels are not additionally strained, because a fusion-operation can be avoided
- In certain cases the percutaneous nucleotomy can be performed under local anaesthesia, thus excluding all risks of general anaesthesia
- A postoperative neck collar is not necessary
- Treatment can be performed on an out-patient basis or patients can be released within 24 hours after the procedure
General pre-operative instructions
Statistics
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Next theme: Spinal Stenosis
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