First ever APCD or Cervical Nucleotomy in Indian subcontinent was successfully performed by Dr Avtar S Matharoo at Fortis Hospital, Mohali.
Nucleotomy is another percutaneousintervention to reduce intradiscal pressure by actually taking out the disc material just like an open surgery minus cutting of bone or tissue. A 2-3mm thick probe is inserted into the center of the disc under X ray guidance (fluoroscopy). An instrument called ‘Nucleotome’ is inserted through the probe which has a cutter inside that operates on pressurized air or nitrogen gas. The cutter cuts the disc material that is sucked outside in a collecting jar for visual inspection.
There are two different types of nucleotomes for working on cervical and lumbar levels. The nucleotome for cervical level is inserted through 2mm thick probe whereas that for lumbar level is inserted through 3mm probe. For cervical discectomy, the procedure is done from the front of the neck whereas for lumbar discectomy, it is done from the back on a patient lying on his belly. In both the situations, the procedure is done in an awake state under local anesthesia only.
The total procedure takes only 30 minutes and the patient is able to go back home walking within next one hour. The procedure at the cervical level is known as ‘Automated Percutaneous Cervical Nucleotomy (APCD)’, whereas the procedure at the lumbar level is called ‘Automated Percutaneous Lumbar Discectomy (APLD)’.
The beauty of this intervention lies in its safety and fast recovery, less pain, no general anesthesia and no hospital stay.
Who is a good candidate?
- Bulging disc where the material inside the disc (nucleus) has not ruptured into the spinal canal
- Symptoms are severe and disabling
- Pain has not improved after four or more weeks of non surgical treatment
- Signs of nerve compression in the leg or arm
- Symptoms are getting worse
- Patients having loss of muscle power in the limbs or permanent numbness in the perineum i.e., the area between the penis or vagina and anus. These are labeled as red flags and may need an urgent surgery to avoid permanent damage.