Transcript applicazione sistematica dell`angio

XIX Symposium Neuroradiologicum
The World Congress of Neuroradiology
Bologna 2010, 4-9 October
Percutaneous nucleoplasty for
discoradicular conflict.
Alexandre A, Alexandre AM*, Corò L
European Neurosurgical Institute (EU.N.I.).
Treviso
*Institute of Radiology - Catholic University of
Sacred Heart. Rome
AIM OF INVESTIGATION
Evaluating clinical results of nucleoplasty on
contained lumbar disc herniations.
NUCLEOPLASTY
Sharps LS, Isaac Z. Percutaneous Disc Decompression Using Nuceoplasty. Pain Physician. Volume 5, 2:121-126. 2002.
Welch WC, Gerszten PC. Alternative strategies for lumbar discectomy: intradiscal electrothermy and nucleoplasty.
Neurosurg Focus 13: 62-68. 2002
MATERIAL AND METHODS
 1390 patients with contained disc herniation (consecutive series
2003 to 2006).
 L3-L4: 234
 L4-L5: 989
 L5-S1: 167
MATERIAL AND METHODS
By posterolateral approach under fluoroscopy through a 17G
needle the SpineWand electrode is introduced and radiofrequency
is applied, to provoke ablation of the nucleus pulposus.
Kambin's Triangle: firstly described by
Kambin in 1972 as a posterolateral
approach for a limited nucleotomy, (safe
triangular working zone).
Base: superior endplate of the inferior
vertebra
Height: lateral border of the tecal sac
Hipotenuse: spinal nerve
MATERIAL AND METHODS
Position of the cannula entering the annulus. Lateral and A-P view.
MATERIAL AND METHODS
RESULTS
(Roland Morris >70% improvement is considered excellent result; 50 to 70% good result.)
Results
12 months
1319 pt
24 months
678 pt
36 months
201 pt
48 months
80 pt
Excellent (70%
improvement)
679
51,47%
334
49,2%
93
46,2%
34
42,5%
Good (50-70%
improvement)
416
31,53%
196
28,9%
50
24,87%
22
27,5%
Insufficient (>50% 112
improvement)
8,49%
88
12,9%
-
-
No result (>20%
improvement)
60
8,9%
58
28,85%
24
30%
112
8,49%
Roland M, Morris R (1983) A study of the natural history of back pain. Spine 8:141–150
RESULTS (Roland Morris improvement)
800
700
600
500
Excellent
Good
Insufficient
No results
400
300
200
100
0
12 Months
24 Months
36 Months
48 Months
RESULTS
 Nucleoplasty is a safe procedure. There have been no
infections, bleeding, nerve root injuries, or worsening of
symptoms after the procedure.
 MRI or CT have been performed 6 months after the procedure,
in 498 cases (total 1319 patients).
 Bulging was eliminated in 128, significantly reduced in 222
and unvaried in 148 cases.
 This case distribution anyway is not directly correlated to
the quality of the clinical outcome.
DISCUSSION
It combines coagulation and ablation for partial removal of the nucleus
pulposus to decompress the disc, without termal or structural damage to
the adjacent tissues*.
Pressure reduction through nucleoplasty is highly dependent on the
degree of degeneration of the spine.
Nucleoplasty markedly reduce intradiscal pressure in nondegenerative
discs, but has a negligible effect on highly degenerative discs**.
*Chen YC, Lee S, Saenz Y, Lehman NL. Histologic findings of disc, end plate and neural elements after coblation of nucleus
pulposus: an experimental nucleoplasty study. Spine Journal 3:466-470. 2003.
**Chen YC, Lee S, Chen D. Indradiscal pressure study of percutaneous disc decompression with nucleoplasty in human
cadavers. Spine 28, 7: 661-665. 2003.
DISCUSSION
The observed initial decreases in interleukine 1, which has hyperalgesic
effects, followed by augmentation in interleukine 8, which may
express the reparatory response, might correspond to the two-step
clinical amelioration, initially due to the rapid discal loss of
volume, and later due to the progressive discal repair.
CONCLUSION

Nucleoplasty is a safe procedure. There have been no
infections, bleeding, nerve root injuries, or worsening of
symptoms after the procedure.

Byochemical modification may correspond to the clinical
result more than morphological ones.

By this minimally invasive procedure patients will not be out
of physiotherapy, and out of normal daily activities for more
than a few days.