Image-guided percutaneous mechanical disc decompression for herniated discs: a technical note

Main Article Content

Alessandro Liguori
Marco Pandolfi
Martina Gurgitano
Antonio Arrichiello
Salvatore Alessio Angileri
Letizia Di Meglio
Anna Maria Ierardi
Aldo Paolucci
Federica Galli
Elvira Stellato
Gianpaolo Carrafiello

Keywords

Disc herniation; percutaneous discectomy; fluoroscopy; spine; interventional radiology; pain management

Abstract

Interventional radiology plays a key role in the treatment of symptomatic herniations of intervertebral discs. Through image-guided techniques, it is possible to use minimally invasive procedures with a percutaneous approach that are usually proposed before classic surgery. Thanks to imaging guidance, it is possible to significantly increase accuracy and decrease complication rates. The pivotal principle of these mini-invasive techniques is to remove a small amount of volume of the nucleus of the intervertebral disc which results in a significant reduction in intradiscal pressure; allowing for a consequent reduction in compression of the nervous structures that generate spinal pain. However, it must be considered that this type of treatment is only addressed to contained disc herniations previously diagnosed with a suitable neuroimaging examination. There are different types of treatment using a variety of chemical, thermal or mechanical processes that result in partial removal of the nucleus pulposus. The purpose of this technical note is to illustrate mechanical disc decompression treatment via a percutaneous approach using the DISKOM device (DISKOM percutaneous discectomy probe, Biopsybell, Mirandola, Italy). Indications, complications and various methods of use are described in relation to the different levels of the spine to be treated.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...
Abstract 1 | PDF Downloads 1

References

1. Manchikanti L, Singh V, Datta S, et al (2009) Comprehensive review of epidemiology, scope, and impact of spinal pain. Pain Physician
2. Singh V, Manchikanti L, Calodney AK, et al (2013) Percutaneous lumbar laser disc decompression: an update of current evidence. Pain Physician
3. Gelalis I, Gkiatas I, Spiliotis A, et al (2019) Current concepts in intradiscal percutaneous minimally invasive procedures for chronic low back pain. Asian J Neurosurg. https://doi.org/10.4103/ajns.ajns_119_17
4. Tassi GP (2006) Comparison of results of 500 microdiscectomies and 500 percutaneous laser disc decompression procedures for lumbar disc herniation. Photomed Laser Surg. https://doi.org/10.1089/pho.2006.24.694
5. Miele V, Andreoli C, Grassi R (2006) The management of emergency radiology: key facts. Eur J Radiol 59:311–4. https://doi.org/10.1016/j.ejrad.2006.04.020
6. Masala S, Massari F, Fabiano S, et al (2007) Nucleoplasty in the treatment of lumbar discogenic back pain: one year follow-up. Cardiovasc Intervent Radiol 30:426–32. https://doi.org/10.1007/s00270-006-0223-4
7. Caranci F, Tedeschi E, Leone G, et al (2015) Errors in neuroradiology. Radiol Med 120:795–801. https://doi.org/10.1007/s11547-015-0564-7
8. Muto M, Ambrosanio G, Guarnieri G, et al (2008) Low back pain and sciatica: treatment with intradiscal-intraforaminal O2-O3 injection. Our experience. Radiol Med 113:695–706. https://doi.org/10.1007/s11547-008-0302-5
9. Grassi R, Lombardi G, Reginelli A, et al (2007) Coccygeal movement: Assessment with dynamic MRI. Eur J Radiol 61:473–479. https://doi.org/10.1016/j.ejrad.2006.07.029
10. Saal JS (1976) The role of inflammation in lumbar pain. Spine Aug
11. Landi A, Gregori F, Mancarella C, et al (2015) Lumbar spinal degenerative “microinstability”: hype or hope? Proposal of a new classification to detect it and to assess surgical treatment. Eur Spine J. https://doi.org/10.1007/s00586-015-4274-6
12. Kelekis AD, Somon T, Yilmaz H, et al (2005) Interventional spine procedures. Eur J Radiol. https://doi.org/10.1016/j.ejrad.2005.03.024
13. Hijikata S (1989) Percutaneous nucleotomy. A new concept technique and 12 years’ experience. Clin Orthop Relat Res 9–23
14. Onik G, Helms CA (1991) Automated percutaneous lumbar discectomy. AJR Am J Roentgenol 156:531–8. https://doi.org/10.2214/ajr.156.3.1899751
15. Amoretti N, Gallo G, Nicolas S, et al (2018) Contained Herniated Lumbar Disc: CT- and Fluoroscopy-Guided Automated Percutaneous Discectomy-A Revival. Semin Intervent Radiol 35:255–260. https://doi.org/10.1055/s-0038-1673361
16. Liguori A, Galli F, Gurgitano M, et al (2018) Clinical and instrumental assessment of herniated discs after nucleoplasty: A preliminary study. Acta Biomed. https://doi.org/10.23750/abm.v89i1-S.7025
17. Kelekis AD, Filippiadis DK, Martin JB, Brountzos E (2010) Standards of practice: Quality assurance guidelines for percutaneous treatments of intervertebral discs. Cardiovasc. Intervent. Radiol.
18. Klessinger S (2018) The frequency of re-surgery after lumbar disc Nucleoplasty in a ten-year period. Clin Neurol Neurosurg. https://doi.org/10.1016/j.clineuro.2018.05.004
19. Buy X, Gangi A (2010) Percutaneous treatment of intervertebral disc herniation. Semin Intervent Radiol. https://doi.org/10.1055/s-0030-1253513
20. Dowling TJ, Dowling TJ (2020) Microdiscectomy
21. Gibby WA (2014) Automated lumbar percutaneous discectomy. Neuroradiology
22. Kloth DA, Fenton DS, Andersson GBJ, Block JE (2008) Intradiscal Electrothermal Therapy (IDET) for the treatment of discogenic low back pain: Patient selection and indications for use. Pain Physician
23. M.V. B, A.M. T, S. D, et al (2007) Interventional techniques: Evidence-based practice guidelines in the management of chronic spinal pain. Pain Physician
24. Gallucci M, Limbucci N, Paonessa A, Splendiani A (2007) Degenerative disease of the spine. Neuroimaging Clin N Am 17:87–103. https://doi.org/10.1016/j.nic.2007.01.002
25. Bogner EA (2009) Past, Present, and Future of Therapeutic Lumbar Spine Interventional Procedures. Radiol. Clin. North Am.
26. Filippiadis DK, Binkert C, Pellerin O, et al (2017) Cirse Quality Assurance Document and Standards for Classification of Complications: The Cirse Classification System. Cardiovasc Intervent Radiol. https://doi.org/10.1007/s00270-017-1703-4
27. Santiago FR, Kelekis A, Álvarez LG, Filippiadis DK (2014) Interventional procedures of the spine. Semin Musculoskelet Radiol. https://doi.org/10.1055/s-0034-1375572
28. Zeidman SM, Thompson K, Ducker TB (1995) Complications of cervical discography: Analysis of 4400 diagnostic disc injections. Neurosurgery. https://doi.org/10.1227/00006123-199509000-00007
29. Smuck M, Benny B, Han A, Levin J (2007) Epidural fibrosis following percutaneous disc decompression with coblation technology. Pain Physician
30. Ierardi AM, Carnevale A, Cossu A, et al (2020) Percutaneous cervical discectomy: retrospective comparison of two different techniques. Radiol Medica. https://doi.org/10.1007/s11547-020-01133-x
31. Nie H yong, Qi Y bin, Li N, et al (2018) Comprehensive comparison of therapeutic efficacy of radiofrequency target disc decompression and nucleoplasty for lumbar disc herniation: a five year follow-up. Int Orthop. https://doi.org/10.1007/s00264-017-3661-5