Standards of Practice: Quality Assurance Guidelines for Percutaneous Treatments of Intervertebral Discs

CardioVascular and Interventional Radiology, Jul 2010

Percutaneous treatments are used in the therapy of small- to medium-sized hernias of intervertebral discs to reduce the intradiscal pressure in the nucleus and theoretically create space for the herniated fragment to implode inward, thus reducing pain and improving mobility and quality of life. These techniques involve the percutaneous removal of the nucleus pulposus by using a variety of chemical, thermal, or mechanical techniques and consist of removal of all or part of nucleus pulposus to induce more rapid healing of the abnormal lumbar disc. These guidelines are written to be used in quality improvement programs for assessing fluoroscopy- and/or computed tomography-guided percutaneous intervertebral disc ablative techniques.

A PDF file should load here. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a PDF plug-in installed and enabled in your browser.

Alternatively, you can download the file locally and open with any standalone PDF reader:

https://link.springer.com/content/pdf/10.1007%2Fs00270-010-9952-5.pdf

Standards of Practice: Quality Assurance Guidelines for Percutaneous Treatments of Intervertebral Discs

Alexis D. Kelekis 0 1 Dimitris K. Filippiadis 0 1 Jean-Baptiste Martin 0 1 Elias Brountzos 0 1 0 A. D. Kelekis (&) D. K. Filippiadis E. Brountzos 2nd Radiology Department, Attikon University Hospital , Rimini 1, 12462 Haidari, Athens, Greece 1 J.-B. Martin Service d'Imagerie Medicale, Geneva University Hospital , 24 Micheli-du-Crest, 1211 Geneva, Switzerland Percutaneous treatments are used in the therapy of small- to medium-sized hernias of intervertebral discs to reduce the intradiscal pressure in the nucleus and theoretically create space for the herniated fragment to implode inward, thus reducing pain and improving mobility and quality of life. These techniques involve the percutaneous removal of the nucleus pulposus by using a variety of chemical, thermal, or mechanical techniques and consist of removal of all or part of nucleus pulposus to induce more rapid healing of the abnormal lumbar disc. These guidelines are written to be used in quality improvement programs for assessing fluoroscopy- and/or computed tomography-guided percutaneous intervertebral disc ablative techniques. - Herniation of intervertebral disc is an important and common cause of low back pain. It affects mobility, physical function, and quality of life, and it costs society much [1, 2]. It is estimated that 7090% of the normal population will experience at least one episode of sciatica or lumbago during their lifetime [3, 4]. Intervertebral disc and discogenic pain have been identified as causative agents in 2639% of patients with sciatica or lumbago [38]. The long-term outcomes, complications, and occasionally suboptimal results that accompany open disc surgery in herniated discs have led to the development of other treatment techniques that avoid an open surgery through the spinal canal. Percutaneous treatments are used in the therapy of small- to medium-sized hernias of intervertebral discs to reduce the intradiscal pressure in the nucleus and theoretically to create space for the herniated fragment to implode inward, thus reducing pain and improving mobility and quality of life [9]. These techniques involve the percutaneous removal of the nucleus pulposus by using a variety of chemical, thermal, or mechanical techniques [1, 913]. They are based on the study of Hijikata et al. in 1975 concerning the role of intradiscal pressure, which stated, Reduction of intradiscal pressure reduced the irritation of the nerve root and the pain receptors in the annulus and peridiscal area [1]. It consists of removal of all or part of nucleus pulposus to induce more rapid healing of the abnormal lumbar disc. These guidelines were written to be used in quality improvement programs for assessing fluoroscopy- and/or computed tomography (CT)-guided percutaneous intervertebral disc ablative techniques. Percutaneous ablative techniques of intervertebral discs are image-guided therapeutic techniques for intervertebral disc hernia, which use a trocar to puncture the outer annulus of the disc. Through this trocar, a variety of chemical, thermal, or mechanical ablative devices may be placed inside the nucleus pulposus, assuring its partial removal. The nuclear material removal internally decompresses the disc with the least disruption of surrounding tissues. Automated percutaneous lumbar discectomy. A pneumatically driven, suction-cutting probe within a 2.8-mm outer diameter cannula removes approximately 13 g of disc material anterior to the herniation. Intradiscal electrothermal therapy (IDET). A flexible thermal resistive coil (electrode or catheter) coagulates the disc tissue with radiant heat (electrothermal energy). Although IDET is used for treatment of the annulus and is not a treatment of the nucleus per se, it is included here as an ablative technique for small contained hernias with ruptures of the annulus. Percutaneous intradiscal radiofrequency therapy may be considered an IDET variant where an electrode or catheter applies alternating radiofrequency current to the nucleus pulposus. Percutaneous laser decompression. Laser energy vaporizes a small volume of nucleus pulposus, thus reducing the intradiscal pressure. Nucleoplasty. A non-heat-driven process where bipolar radiofrequency energy causes molecular dissociation and dissolves nuclear material creating a series of intradiscal channels. Percutaneous disc decompression. Nuclear material extraction is achieved with a mechanical device with high rotations per minute and with spiral tips. Ozone therapy. Ozones chemical properties and the reaction of hydroxyl radical with carbohydrates and amino acids leads to breakdown of nucleus pulposus, with rapid disappearance of herniated material. DiscoGel. A chemonucleolytic agent (gelified ethanol) that causes dehydration of nucleus pulposus, thus resulting in retraction of intervertebral disc herniation. Small- to medium-sized contained intervertebral disc herniation confirmed by magnetic resonance imaging (MRI) [1215]. Back pain of disc (...truncated)


This is a preview of a remote PDF: https://link.springer.com/content/pdf/10.1007%2Fs00270-010-9952-5.pdf

Alexis D. Kelekis, Dimitris K. Filippiadis, Jean-Baptiste Martin, Elias Brountzos. Standards of Practice: Quality Assurance Guidelines for Percutaneous Treatments of Intervertebral Discs, CardioVascular and Interventional Radiology, 2010, pp. 909-913, Volume 33, Issue 5, DOI: 10.1007/s00270-010-9952-5