WHAT IS CERVICAL COBLATION NUCLEOPLASTY?
Cervical coblation nucleoplasty (CCN) is a minimally invasive outpatient surgical technique for
treating disc herniations of the neck. It is a technique developed by Arthrocare.
HOW IS CCN PERFORMED?
With the patient in the operating room lying on their back, sedation is given via IV, and
fluoroscopic (xray) guidance is used to place a moderately small needle (19 ga) into the neck and
into the herniated disc of the spine. Through this needle is passed a coblation wand which has a
small loop on the end. This loop is energized with radiofrequency energy and upon rotation of the
loop, small amounts of disc tissue are carved from the middle to back of the disc. The removal of
small amounts of disc tissue is often all that is required to reduce pressurization of the dusc and
annulus thereby reducing the pressure on the nerve root.
HOW DOES CCN COMPARE WITH TRADITIONAL SURGERY FOR DISC HERNIATIONS?
CCN is less invasive, usually has a more rapid recovery time due to the fact that nothing is fused
and that there are no large incisions or significant tissue disruption.
IS CCN EXPERIMENTAL?
No. The FDA has given 510K device clearance which is an investigational device. It does not
mean the device is experimental in any way. Medicare and most insurance companies pay for
CCN. Since by law Medicare cannot pay for experimental treatments, the fact that Medicare does
reimburse for the procedure demonstrates the US Government does not believe the procedure is
experimental.
WHAT ARE THE POTENTIAL COMPLICATIONS OF SUCH A THERAPY?
Bleeding, infection inside the disc, infection inside and outside the disc along the cervical spine,
disciitis (infection of the endplates and bone of the disc), perforation of the lung, perforation of the
lung, blood vessels of the neck, thoracic duct (lymphatic tissue of the neck), nerve injury to the
nerve roots or to the spinal cord itself, failure to relieve pain, need for further open surgery such
as laminectomy or discectomy, and several others
ARE THERE ANY SCIENTIFIC STUDIES ON CERVICAL COBLATION?
There is sparse data available, however one excellent study with a one year followup was
presented at ISMISS in 2005. Click on the literature link to the left to access the findings of this
study. My outcome experience is approximately 2/3 will derive significant pain relief with the
arm and hand pain relief being more effective than the neck pain.
HOW DO SURGEONS OBTAIN TRAINING IN THIS TECHNIQUE?
Primarily through experience with other similar techniques used in the cervical spin. It is
unknown if university programs tech the technique. ONLY HIGH LEVEL PHYSICIANS WITH
YEARS OF EXPERIENCE IN PAIN MANAGEMENT SHOULD ATTEMPT THIS PROCEDURE.
WHAT ARE THE ALTERNATIVES TO CCN?
Cervical fusion, cervical traction, physical therapy, endoscopic laser discectomy, medication
management only.
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