Keywords:
Interventional non-vascular, Musculoskeletal spine, Neuroradiology spine, Fluoroscopy, Percutaneous, MR, Ablation procedures, Motility, Hernia
Authors:
P. Nikolopoulos, P. Maniatis, A. P. Giannila, A. D. Kelekis, J. Papailiou, C. Triantopoulou; Athens/GR
DOI:
10.1594/ecr2012/C-2358
Methods and Materials
Thirteen patients (9 men and 4 women) with low back and leg pain underwent nucleoplasty in our department during the last 18 months,
after failure of conservative therapy for at least 6 weeks.
All patients had MRI proven small to medium size disc protrusion/herniation with preserved disk height of at least 50% (Fig 1).
The coblation bipolar device (SpineWand,
Arthrocare,
USA) was introduced in the nucleus pulposus through a 17 Gauge Trocar (Crawford ,
6”,
Arthrocare), positioned parallel to and at midway between the two end plates under fluoroscopic control (Fig 2,3).
Radiofrequency driven molecular dissociation and removal of nuclear material at relatively low temperatures (typically 40°C to 70°C) was used to create six channels at the two,
four,
six,
eight,
ten and twelve o’clock positions,
to ensure adequate decompression of the disc space,
by slightly rotating the coblation electrode (Fig 4).
Provocative discography was performed in 4 patients prior to the percutaneous disc decompression (Fig 5).
Selective Neural Root Block was performed in all patients immediately after nucleoplasty with 1.0 ml of betamethasone sodium phosphate and betamethasone acetate (Celestone Chronodose) and 1.0 ml of Bupivacaine 0.5% (Fig 6,7).
The visual analogue pain scale (VAS) was used to document the pain perception of patients before and up to 12 months following coblation.
Follow up MRI to assess size disc protrusion/herniation was performed at 3 months.