Microdiscectomy vs Nucleoplasty

Nucleoplasty and microdiscectomy are surgical procedures used to decompress bulging or herniated intervertebral discs. While microdiscectomy is a standard treatment for herniated discs, nucleoplasty is a novel minimally invasive technique to decompress small bulging of the intervertebral disc. Both the procedures result in relief from discogenic pain and radiculopathy.

Low back pain is a very common complaint in middle age and elderly adults that may result in loss of work and dissatisfaction in activities of daily living. A number of patients with low back pain may have herniated or bulging intervertebral discs. The patients frequently complain of low back pain radiating to the buttocks and the back of the thighs, a condition commonly known as sciatica.

MRI of the lumbar spine in the sagittal section showing L4-L5 disc herniation.

MRI of the lumbar spine in the sagittal section showing L4-L5 disc herniation.


The intervertebral discs are present between the vertebral bodies. The disc is designed to cushion the impact of body movements on the spine. The discs consist of an outer dense ring known as annulus fibrosus and an inner soft core known as nucleus pulposus. The nucleus pulposus has a watery consistency which is responsible for the cushioning action of the disc. The annulus fibrosus on the other hand provides structural strength to the intervertebral disc.

The disc in the spine may degenerate with age, especially in the lower back as the region supports the majority of the upper body weight. The outer annulus fibrous ring may develop cracks and fissures due to disc degeneration. The inner nucleus pulposus loses watery content with age which in turn leads to a decrease in the disc height.

The presence of cracks in the outer ring along with increased pressure in the lower back may lead to bulging of the inner nucleus through the ring. The bulging may advance to herniation of the nucleus pulposus or in advanced cases extrusion of the disc contents.

The bulging or herniation may also occur as a result of repetitive action and lifting of a heavyweight without proper support and in a bad posture. The herniation and subsequent loss of disc height may lead to degenerative changes in the involved segment. There may be the formation of bone spurs and facet joint degeneration.

The herniation or bulging may compress the spinal nerve roots exiting or traversing the involved segment. The compression leads to irritation and symptoms of lumbar radiculopathy in the involved nerve root.

Patients may complain of sharp shooting pain in the back or front of the thighs. Some patients may also complain of numbness or tingling in the legs. In severe compression there may be a weakness of the muscles in the lower limbs and patients may have difficulty walking, standing, or climbing stairs. The nerves supplying the involved intervertebral disc and the facet joint are also irritated leading to back pain.

The initial management of discogenic back pain is nonsurgical. The physician may prescribe pain medications such as Tylenol and ibuprofen. Activity modification and posture correction are also recommended along with physical therapy. The patients who do not benefit from nonsurgical methods of treatment for at least 6 weeks may be candidates for surgical management. The type of surgical management depends upon the underlying condition and the severity of the symptoms.

Nucleoplasty is a minimally invasive surgical technique that allows the surgeon to decompress the nerves. Minimally invasive surgery means there is minimum trauma to the structures surrounding the disc while performing the surgery. Nucleoplasty may be performed in an outpatient setting under local anesthesia. The patient remains semi conscious during the procedure while the area where the surgery is performed is anesthetized.

After adequate anesthesia, the surgeon inserts a needle in the involved intervertebral disc. The needle is guided by an external x-ray image intensifier. After the correct position of the needle is verified, the surgeon inserts a thermal-cautery/radiofrequency device. The thermal cautery or the radiofrequency device works by heating the nucleus pulposus.

The heating of the nucleus pulposus leads to shrinkage of the nucleus pulposus (nucleoplasty). The heat generation also leads to the remodeling of the annulus fibrous ring. The shrinkage of the pulposus along with the closure of the cracks leads to relief from disc bulge. After the needle is withdrawn, the entry site is closed with a bandage.

While the heat helps in the shrinkage of the nucleus pulposus, the surrounding tissues such as nerves, muscles, and bone is not damaged. The procedure involves minimum cutting of the tissues leading to a quicker rehabilitation. The patients are able to go home the same day of the procedure.

Microdiscectomy surgery involves a small incision and removal of the herniated disk under the direct vision of the surgeon. The procedure may be performed under general anesthesia in a hospital or in an outpatient setting under local anesthesia. The surgeon carefully separates the tissues to reach the involved spine segment. A small part of the lamina is removed to visualize the intervertebral disc.

The surgeon carefully retracts the spinal nerve roots and punches out small bits of the herniated intervertebral disk. The surgeon may also remove any bone spurs and widen the spinal canal in case of spinal stenosis. The procedure may be performed with an open traditional approach or using an endoscope (minimally invasive technique).

While nucleoplasty is less invasive than microdiscectomy, nucleoplasty can only be performed in limited circumstances. Nucleoplasty is only performed in patients in whom there is a single-level disc bulge. The procedure is limited to patients in whom the cause of symptoms is diagnosed to be solely because of the disk. Similarly, herniation and extrusion of the disc are managed with microdiscectomy rather than nucleoplasty. Nucleoplasty is only used to treat disc bulges with less than 50% loss of diameter.

Microdiscectomy may be combined with laminectomy surgery to relieve symptoms of spinal canal stenosis. Spinal lumbar fusion surgery is better suited in cases of spine instability. Both nucleoplasty and microdiscectomy are highly successful procedures for the management of discogenic pain. Speak with your spine surgeon to determine the procedure best suited for your condition.

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Based on 96 reviews
No one likes going to the doctor. But these people make it painless. I go for knees, hips and shoulders. At almost 70 Complete Orthopedics keeps my active life style running smoothly. Whether chasing my Grandson and even surfing again, I highly recommend them!!
Thomas Slavin
15:02 02 Mar 23
Dr. Kuo knowledgeable and competent surgeon- very good experience and more importantly great result.
Joseph McCoy
21:23 25 Feb 23
Dr Vaksha was so kind and helpful. He took extra time with us and explained things so thoroughly. Highly recommend. Office very clean.
Susan Bosinius
20:20 19 Feb 23
Dr Vaksha, is a great doctor very professional knows what he talking about. Treat patient with upmost respect. Thank You
Troy Spencer
16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
blanca ventura
21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
Ita Opico
19:01 25 Oct 22
Love this place From the minute I called I was treated kindly. When I arrived The Dr saw me right away he was compassionate and ordered the appropriate tests for me. I came back in for my follow up and had the same great experience.
Christine Rostock
21:28 23 May 22
Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best.
Harry Jones
23:31 19 May 22
Complete orthopedics is a wonderful place to go when you hurt or injured a great staff and wonderful doctors very knowledgeable and helpful I would recommend this place to all of my family and friends that is in me of orthopedic care I give them 10 thumbs up
Wayne Pemberton
17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
Phoenix Rising
19:54 16 May 22
Dr.Karkare is the best. He listens to everything and explains everything I recommend him to everyone. I am so happy he is my doctor.
Myrna James
00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
Erick Murillo
23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
Yolanda Ojeda
19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
John Senechal
19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
00:46 03 May 22
I have seen Dr. Kuo two times already and he's awesome along with his staff. Very friendly office and I'm glad to be a patient here.
Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
breidy valerio
19:01 22 Apr 22
The staff is truly exceptional, they make you feel comfortable and welcomed. The doctors are amazing,always professional, compassionate and great listeners.
Elizabeth Collado
03:25 09 Apr 22
What a great place! The place is clean and organized.The staff is wonderful. Setting up physical therapy is right there as well.I'm so glad I found this place.
Donna Anne
22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs
Mirna Caballero
14:53 03 Mar 22
Great staff. Dr. Vaksha is awesome and takes the time to listen to his patients. He is very compassionate. I would highly recommend this office.
Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
Elizabeth Birchwell
21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
Joe Allen
17:26 17 Nov 20
Linda and Becca they are so good ever time I come they are very nice I would tell everyone I no to come to this office..
Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
Ryan Brigandi
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18

My name is Dr. Suhirad Khokhar, and am an orthopaedic surgeon. I completed my MBBS (Bachelor of Medicine & Bachelor of Surgery) at Govt. Medical College, Patiala, India.

I specialize in musculoskeletal disorders and their management, and have personally approved of and written this content.

My profile page has all of my educational information, work experience, and all the pages on this site that I've contributed to.