Nucleoplasty-coblation by radio frequency     (D.WERNER,Germany)

 

Minimally invasive techniques are becoming more and more important in the treatment of lower back pain.

The goal is to disturb and destroy as little as possible of the existing structures at the spine.

The causes of pain at the spine can be complex.

This requires an accurate diagnosis of the causes of the back pains.

The diagnosis must be composed of thorough clinical evaluations, conventional X-rays, MRI and provocative discography.

Especially discography is of importance in the diagnosis of lower back pain related herniated discs.

It is the basis of successful application of minimally invasive techniques.

Coblation nucleoplasty seeks to lessen the intradiscal pressure.

This process will vaporize nuclear tissue which will escape through the Coblation probe.

The subsequent application of heat causes the nuclear tissue to shrink.

Depending on the number of applications of the Coblation - probe as one pushes it into the tissue of the intravertebral discs one can reduce the mass of the nucleus a predetermined amount.

In this way it is possible to vaporize more or less of the tissue of the center of the intravertabral discs depending on the results of the provocative discography.

The goal of the operation should always remain to destroy as little as possible of the elasticity of the intravertabral discs.

One can imagine another effect but this remains in clinical testing.

One can detect in follow-up visits of certain patients a definitely faster and better pain reduction.

These are the patients where discography revealed a painful lesion of the intravertabral discs which was treated with a very extensive dorsal coblation and hence at the lower dorsal curve of the intravertabral disc.

This lead to a lateral relocation of the accessway to the intravertabral disc.

Hence the area of effectiveness of the coblation will be more dorsal.

This observation is prominent due to the small number of cases but not yet statistically verified.

In particular intravertabral discs, which show (during discography using the application of dye) extensive vulcanization and high pain during the increasing intradiscal pressure, indicate the need for a coblation.

The success of this method is dependent on the previous diagnosis.

Hence combined pain syndromes caused not only by discs but also by things like Facet pain or radicular symptom caused by a free fragment, can only be partially treated.

Coblation is used successfully in combination with other minimally invasive techniques for some time in our clinic.

Dependent on the results of provocative discography, combining in the coblation operation methods like selective endoscopic microdiscectomy or endoscopic Foraminoplasty has shown itself to be effective.

When the space above and/or below a definitive painful intravertabral disc is not definitely pain-free and a herniated disc cannot be verified then a combination such as discussed above is indicated.

This combination treatment shows a markedly reduced reconvalescence and lessend post-operative use of pain-relievers.

Since the number of cases is still small, one should use personal observations as the goal for subsequent evaluations so that statistically relevant data can be obtained.