Standards of Practice: Quality Assurance Guidelines for Percutaneous Treatments of Intervertebral Discs
Alexis D. Kelekis
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Dimitris K. Filippiadis
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Jean-Baptiste Martin
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Elias Brountzos
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A. D. Kelekis (&) D. K. Filippiadis E. Brountzos 2nd Radiology Department, Attikon University Hospital
, Rimini 1, 12462 Haidari,
Athens, Greece
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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.
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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)