Ann Rehabil Med.  2017 Feb;41(1):80-89. 10.5535/arm.2017.41.1.80.

Clinical Efficacy of Selective Focal Ablation by Navigable Percutaneous Disc Decompression Device in Patients With Cervical Herniated Nucleus Pulposus

• Kim SH
• Lee SH
• Kim NH
• Kim MH
• Park HJ
• Jung YJ
• Yoo HJ
• Meng WJ
• Kim V

• KMID: 2383681
• DOI: http://doi.org/10.5535/arm.2017.41.1.80

Abstract

OBJECTIVE
To evaluate the clinical efficacy and safety following percutaneous disc decompression, using navigable disc decompression device for cervical herniated nucleus pulposus (HNP).
METHODS
Twenty subjects diagnosed with cervical HNP and refractory to conservative management were enrolled for the study. The herniated discs were decompressed under fluoroscopic guidance, using radiofrequency ablation device with navigable wand. The sagittal and axial plain magnetic resonance images of the clinically significant herniated disc, decided the space between the herniated base and outline as the target area for ablation. Clinical outcome was determined by Numeric Rating Scale (NRS), Neck Disability Index (NDI), and Bodily Pain scale of Short Form-36 (SF-36 BP), assessed after 48 weeks. After the procedure, we structurally matched the magnetic resonance imaging (MRI) and C-arm images through bony markers. The wand position was defined as being "˜correct' if the tip was placed within the target area of both AP and lateral views; if not, the position was stated as "˜incorrect'.
RESULTS
The average NRS fell from 7 to 1 at 48 weeks post procedure (p<0.05). In addition, statistically significant improvement was noted in the NDI and SF-36BP (p<0.05). The location of the wand tip resulted in 16 correct and 4 incorrect placements. Post-48 weeks, 3 of the incorrect tip cases and 1 correct tip case showed unsuccessful outcomes.
CONCLUSION
The study demonstrated the promising results and safety of the procedure. Thus, focal plasma ablation of cervical HNP with navigable wand can be another effective treatment option.

Keyword

Cervical spine; Minimally invasive; Catheter ablation; Neck pain

MeSH Terms

Catheter Ablation
Decompression*
Humans
Intervertebral Disc Displacement
Magnetic Resonance Imaging
Neck
Neck Pain
Plasma
Treatment Outcome*

Figure

• 

  Fig. 1 The wand and navigable tip of the L'DISQ-C is illustrated (A). The tip of the wand can be curved to the desired angle by rotating the control wheel (B, C). After placing the tip into the posterior annulus, plasma energy induced by radiofrequency is used to ablate and decompress the target disc herniation. A turning radius of distal tip is 17 mm and a diameter of wand is 1.0 mm.

• 

  Fig. 2 (A-D) Final tip placement of magnetic resonance imaging and C-arm images were structurally matched through the bony markers (a, anterior vertebral line; b, posterior vertebral line; c, spinolaminar line; d & f, lateral vertebral lines; e, spinous process line; g & h, adjacent endplate lines).

• 

  Fig. 3 Clinical outcomes of all patients (median value). (A) The serial Numeric Rating Scale (NRS). (B) The serial Neck Disability Indexes (NDI). (C) The serial Bodily Pain scales of Short Form-36 version 2 (SF-36 BP). The figure documents statistical improvement (*p<0.05) during the period between initial and post-48 weeks in all outcome measurements.

• 

  Fig. 4 (A) Pre-procedure magnetic resonance imaging noted a bulging herniated disc at C6/7. (B) A post-procedure computed tomographic scan illustrates the probable results of radiofrequency ablation as indicated by opacity (arrow) around the treated disc herniation.

• 

  Fig. 5 (A, B) Pre-procedure magnetic resonance imaging noted a bulging herniated disc at C5/6, central to left. (C) Final tip placement of C-arm image on coronal view. (D) Incorrect final tip placement of C-arm image on sagittal view. The wand tip (dotted circle) was placed on more inner side beneath the posterior vertebral line (dotted line) and the tip could not approach the herniated target area.

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