Radiofrequency Nucleoplasty Procedure

A 17-gauge needle is percutaneously inserted. The tip of the 17-gauge needle must reach the posterior part of the nucleus pulposus. The tip of the needle is placed at the nuclear/annular junction (Fig. 4A), so that when the device is introduced through the needle, the active tip may pass directly into the nucleus.

Tissue removal creates channels through the nucleus to the opposite (anterior) side of the disc, where a depth stopper prevents ablation into the annulus. Prior to the activation of the

FIGURE 3 Percutaneous laser disc decompression. L4-L5 disc herniation. (A) The 18-gauge needle is positioned in the nucleus under fluoroscopic guidance. (B) Computed tomography control before vaporization. (C) Vaporization of the nucleus.

FIGURE 4 Percutaneous radiofrequency nucleoplasty in a posterolateral L5-S1 disc herniation. (A) The tip of the 17-gauge needle is placed under fluoroscopy at the nuclear/annular junction. (B) Tissue removal creates channels through the nucleus to the opposite (anterior) side of the disc. (C) Needle position (the SpineWand™) in the nucleus, computed tomography control.

FIGURE 4 Percutaneous radiofrequency nucleoplasty in a posterolateral L5-S1 disc herniation. (A) The tip of the 17-gauge needle is placed under fluoroscopy at the nuclear/annular junction. (B) Tissue removal creates channels through the nucleus to the opposite (anterior) side of the disc. (C) Needle position (the SpineWand™) in the nucleus, computed tomography control.

FIGURE 5 L5-S1 disc herniation. Radiofrequency nucleoplasty under computed tomography (CT) and fluoroscopy guidance. (A) 17-gauge needle placement under fluoroscopy control. (B) Tissue removed by SpineWand™ is visualized by CT scan: gas filling the disc.

device, fluoroscocopic and/or CT confirmation of the placement of the device and the extent of the channel is advisable.

Patient must be monitored for pain during the whole intervention, and the needle has to be repositioned if radicular pain occurs. In order to confirm contained disc herniation or if any doubt persists, a discography can be performed just before nucleoplasty.

While monitoring the patient, the SpineWand is advanced into the disc under continuous fluoroscopy control. As the SpineWand is advanced, the Coblation plasma mode is activated, so that tissue along the path of the device is removed (Fig. 4B and C) (30).

After stopping at a predetermined depth (prior to reaching the anterior annulus), the SpineWand is slowly withdrawn, in coagulation mode, to the starting position. During withdrawal, RF heating at the tip of the device causes the adjacent tissue to coagulate, with the result that the ablation channel is thermally treated. Sufficient thermal energy is generated to denature nerve fibers adjacent to the channel within the nucleus pulposus.

After the first channel is created, the SpineWand is rotated clockwise. As the SpineWand device is curved, each rotation changes its direction and creates a new channel inside the nucleus. Approximately 6 to 12 channels are created in total, depending on the desired amount of tissue reduction (Fig. 5).

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