Nucleoplasty – Coblation
A minimally invasive approach
for the percutaneous decompression of herniated discs
N.
Jucopilla, C.Ferrarese, G.Tirapelle, G. Mazzo, A. Robert
Divisione
Ortopedia – Traumatologia dellŽOspedale Zavarise Manani San Bonifacio/
Verona, Italia
This method proposed by
the american Conor oŽNeill, MD, realizes ablation and coagulation of symptomatic
nuclear disc material by means of bipolar radiofrequency, creating an
ionized vapor layer called plasma.
Coblation – channelling
via this ionized vapor layer induces a molecular dissociation in the soft
tissues of the discal sector operated with controlled thermal effect (40
– 70°C) on the adjacent structures (No iatrogenic collateral damage on
the cartilageneous endplate
and the nervous structures).
Coblation Nucleoplasty
(C. N.) thus provides for a mechanical decompression (homogeneous redistribution
of intradiscal pressure,
remodelling of the discal frame, reduction of the asymmetrically protruded
hard tissue cone) due to the anular fenestration as well as the discal
enucleation induced. This results in an attenuation of chemo – antigenic
aspects that come with the pathology of disc herniation.
Clinical and radiological indications
- Lumboradicular syndrome
with irritation or mild deficit caused by contained disc herniation,
subligamentar, non migrated, small to mid - sized, “reducibile“, of
volume inferior to 1/3 of the canal diameter in absence of osseous stenosis
and instability.
- Lumbalgic discogeneous
syndrome caused by intraanular herniation.
Technical aspects
The approach is the classical
postero – lateral one of the percutaneous methods. Surgery is performed
in local anestesia, under constant monitoring with image intensifier.
We use a 17 gauge needle
with a Crawford point and obturator. Once the correct positioning of the
needle in the discal frame is confirmed, the electrode is introduced into
the discal nucleus activating ablation on advance and coagulation upon
retraction of the wand electrode.
6 intradiscal tunnels
are created rotating the wand electrode in clockwise direction (Advancing
and retracting the wand at 2, 4, 6, 8, 10 and 12 oŽclock). Duration of
therapy five minutes.
Methods
From March to July 31,
2001 27 patients underwent C. N. with a minimal follow- up of 30 days
(18 males and 9 females aged between 18 and 52 years). The level most
frequently treated was L4/ L5 (70,4%) followed by L5/ S1 (22,2%) and L3/
L4 (7,4%).
21 patients were affected
by lumbosciatic pain and/ or sciatic pain with clear prevalence of radiated
pain, 6 patients presented with a “pure“ lumbalgic syndrome and positive
disc test.
Results
Evaluation of results
was performed following the criteria of McNab demostrating 81,5 %
excellent or good outcomes and 18,5 % of outcomes not completely
satisfying. No general complications (nervous or vascular lesions, infections)
or such specific of the method (undesired diffusion of applied energy)
were encountered.
Conclusion
We were interested in
evaluating this recently proposed method which blends in well with the
vast array of therapeutic options for lumbar disc herniation. Even though
its practice is recent (statistically significant data and retrospective
follow- ups are not available to date), its characteristics make it an
interesting alternative to other percutaneous treatment. We performed
this method on 27 highly selected cases with good results in 81,5 %.
References
N. Jucopilla, A. Robert:
Nucleoplasty: A minimally invasive option for percutaneous disc decompression.
Presented at the International Symposium of the Swiss Spine Institute,
Zurich, June 8 – 9, 2001.
Vijay Singh, MD: Percutaneous
Disc Decompression Using Nucleoplasty. Presented at The Annual Meeting
Florida Pain Society, Miami, Florida, June29th – July 1st, 2001.
