Clinical Efficacy of Selective Focal Ablation by Navigable Percutaneous Disc Decompression Device in Patients With Cervical Herniated Nucleus Pulposus

Abstract

Objective To evaluate the clinical efficacy and safety following percutaneous disc decompression, using navigable disc decompression device for cervical herniated nucleus pulposus (HNP). Methods Twenty subjects diagnosed with cervical HNP and refractory to conservative management were enrolled for the study. The herniated discs were decompressed under fluoroscopic guidance, using radiofrequency ablation device with navigable wand. The sagittal and axial plain magnetic resonance images of the clinically significant herniated disc, decided the space between the herniated base and outline as the target area for ablation. Clinical outcome was determined by Numeric Rating Scale (NRS), Neck Disability Index (NDI), and Bodily Pain scale of Short Form-36 (SF-36 BP), assessed after 48 weeks. After the procedure, we structurally matched the magnetic resonance imaging (MRI) and C-arm images through bony markers. The wand position was defined as being ‘correct’ if the tip was placed within the target area of both AP and lateral views; if not, the position was stated as ‘incorrect’. Results The average NRS fell from 7 to 1 at 48 weeks post procedure (p<0.05). In addition, statistically significant improvement was noted in the NDI and SF-36BP (p<0.05). The location of the wand tip resulted in 16 correct and 4 incorrect placements. Post-48 weeks, 3 of the incorrect tip cases and 1 correct tip case showed unsuccessful outcomes. Conclusion The study demonstrated the promising results and safety of the procedure. Thus, focal plasma ablation of cervical HNP with navigable wand can be another effective treatment option.

Percutaneous plasma laser disc coagulation and navigable ablation decompression in the treatment of cervical disc herniation: A single center experience.

“…There are some nonsurgical interventions for the treatment of CDH that usually aim to directly cauterize the discal parts, making use of various devices that approach anteriorly to the cervical disc (11,12). There is a need for comparative studies analyzing the results and long-term effects of these methods.…”

The Effect of Initial Visual Analog Scale Score on Results in Cervical Laser Discectomy

“…The concept of intra discal electrothermal therapy (IDET) is generally used to describe the methods used to achieve the thermal ablation of the intervertebral discs. This thermal ablation can be achieved with radiofrequency waves or laser energy (1,9). While naming the prosedure, the names "percutaneous disc coagulation" (PDC), "anuloplasty", and "nucleoplasty" are far from explaining what kind of energy ablation is used.…”

“…When this theory did not find much support, new devices have been developed which aiming to coagulate anulus fibrosus (AF) rather than nucleus pulposus, considering that the pain is actually due to degenerated AF. Thus, the systems that are contacting the inner surface of the AF by using guidable catheters and thus coagulating a larger AF region were developed (4,5,9). But in recent studies, contrary to the previously known, it has been shown that there are newly sprouted nerve endings into the degenerated nucleus pulposus (NP) due to degenerative processes, and these new nerve endings may be responsible for discogenic pain (13,14).…”

Effectiveness of Percutaneous Intradiscal Decompression Therapy in Thoracic Disc Herniation

“…Lee et al ( 20 ) evaluated data of patients with both radicular and axial pain ( 18 ) and with discogenic waist pain ( 21 ) who had lumbar disc decompression performed using L’DISQ TM . Kim et al ( 22 ) studied patients with cervical herniated nucleus pulposus who were resistant to prior treatments. They concluded that the technique was effective in the cervical region as well as the lumbar region.…”