J Korean Neurosurg Soc.  2012 Jan;51(1):8-13. 10.3340/jkns.2012.51.1.8.

Clinical Outcomes of Percutaneous Plasma Disc Coagulation Therapy for Lumbar Herniated Disc Diseases

• Kim SH
• Kim SC
• Cho KH

• KMID: 2190461
• DOI: http://doi.org/10.3340/jkns.2012.51.1.8

Abstract

OBJECTIVE
This is prospective study of clinical outcomes of percutaneous plasma disc coagulation Therapy (PDCT) in patients with herniated lumbar disc disease (HLD) to evaluate the safety and efficacy in its clinical application and usefulness as a reliable alternative to microscopic discectomy.
METHODS
Forty-six patients were enrolled in this study from April 2006 to June 2010. All patients had one-level HLD. Disc degeneration was graded on routine T2-weighted magnetic resonance Image (MRI) using the Pfirrmann's grading system and all index levels were grade 3 and grade 4. Indications for surgery were radiculopathy caused by disc protrusion with soft consistency. MRI was done at one month after the procedure in all patients to check post-PDCT change. The clinical outcomes were evaluated using Visual Analog Scales (VAS) score and MacNab's criteria.
RESULTS
This study was approved by the Institutional Review Board of our institution. The age of the study population ranged from 16 to 59 years with a mean age of 37.2 years. There were 29 males and 17 females in this study. The mean period of clinical follow-up was 21 months. The average preoperative VAS score for radiculopathy was 7.4+/-1.4, while the final follow-up VAS score was 1.4+/-0.7 (p<0.001). In MacNab's criteria, 41 patients (89.1%) had achieved favorable improvement (excellent and good) until later follow-up. There were one patient from infection and two patients who needed to convert to open discectomy.
CONCLUSION
PDCT is a safe and efficient treatment modality in a selective patient with HLD.

Keyword

Intradiscal; PDCT; Herniated lumbar disc; Disc coagulation

MeSH Terms

Ethics Committees, Research
Female
Follow-Up Studies
Humans
Intervertebral Disc Degeneration
Intervertebral Disc Displacement
Magnetic Resonance Spectroscopy
Male
Plasma
Prospective Studies
Radiculopathy
Weights and Measures
Intervertebral Disc Degeneration
Intervertebral Disc Displacement

Figure

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  Fig. 1 The first lesion (a) was made transitional area between annulus fibrosus and nucleus pulposus which was just beneath the herniated disc portion. The second lesion (b) was made at the center of intervertebral disc. The third lesion (c) was made between (a) and (b). Three lesions which are made by fireball are communicated each other and the sufficient decompression of intradiscal volume can be achieved.

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  Fig. 2 Mean VAS score was improved from 7.43 to 2.37 immediately after the procedure and well maintained until final follow-up. VAS : Visual Analog Scales, PDCT : percutaneous plasma disc oagulation therapy.

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  Fig. 3 Forty-one patients (89.1%) showed excellent and good clinical result in modified MacNab's criteria right after the procedure and well maintained until final follow-up.

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  Fig. 4 A female patient (24 years old) who had great improvement right after PDCT. She took post-PDCT MRI one month later which showed improved disc herniation at the corresponding level. PDCT : percutaneous plasma disc oagulation therapy, MRI : magnetic resonance image.

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  Fig. 5 Comparison between conventional laser and PDCT. Conventional laser uses directional laser beam energy that can be accumulated and penetrated to anterior structure of disc which can cause injury of anterior longitudinal ligament, bowels, nerve root, and end-plate. Conventional laster cannot provide sufficient energy to disc itself. PDCT uses plasma laser. The major difference of the plasma light from conventional laser is that the rays generated in the module are concentrated at the end of the fiber and do not travel linearly. The plasma light without directionality creates fireball and provides sufficient effect with the least output power because all the energy is concentrated at the tip of the fiber. PDCT : percutaneous plasma disc oagulation therapy.

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