percutaneous intradiscal decompression

Because of the high pressure in the intervertebral disc, low back pain can be treated by percutaneous disc decompression. Intervertebral disc decompression can remove part of the nucleus pulposus tissue, reduce the volume in the intervertebral disc, and reduce the pressure in the intervertebral disc, thus alleviating the symptoms of such patients. The total success rate of percutaneous disc decompression is 70% to 90%. There are many methods for intervertebral disc decompression, including percutaneous puncture papain nucleation, percutaneous puncture nucleus pulposus and aspiration, percutaneous laser decompression and percutaneous puncture nucleus pulposus. Their operating procedures are basically the same, except for the way the nucleus pulposus is removed. In recent years, percutaneous laser decompression and percutaneous puncture nucleus pulposus are most commonly used. The following is an example of percutaneous disc nucleus decompression (nucloueplasty). Treatment of diseases: lumbar disc herniation Indication Percutaneous disc decompression is suitable for: 1. Intervertebral disc disorders and early degenerative disc disease. 2. Inclusive disc bulging or protruding. 3. Discography can induce the same symptoms of low back pain in peacetime. Contraindications 1. Discography shows the rupture of the annulus fibrosus. 2. Disc herniation or protrusion combined with spinal stenosis. 3. With nerve paralysis (muscle strength, etc.). 4. Disc herniation or protrusion of spinal cord or cauda equina syndrome. 5. There is a history of injection in the spinal canal. 6. Disc herniation or protrusion accompanied by instability of the lumbar spine. 7. Patients with vertebral body, intervertebral space or intraspinal infection. Preoperative preparation 1. Do an iodine allergy test and select a contrast agent for spinal angiography as a contrast agent for the intervertebral disc. 2. Explain to the patient the sensation of doing discography, whether the pain is the same as the onset (part and nature). Surgical procedure 1. First discography (discogrophy). Using a 17G puncture needle, select the symptomatic side of the midline of the spine to open 8 to 10 cm, 45° to 55° to the sagittal plane of the median line, and the direction of the needle and the intervertebral space parallel to the center of the intervertebral disc, to the intervertebral The needle enters the needle in the direction of the hole and enters the intervertebral disc through the posterior lateral angle of the disc. 2. The puncture needle should reach the nucleus pulposus of the intervertebral disc. The orthotopic position should exceed the inner edge of the pedicle, and the line should be connected to the middle of the intervertebral disc. 3. Inject the contrast agent and observe the diffusion of the contrast agent, whether it leaks into the range other than the intervertebral disc, mainly whether it can induce the same symptoms of low back and leg pain in peacetime, such as the same symptoms of low back and leg pain in peacetime, and If the contrast agent does not leak outside the disc, the intervertebral disc decompression can be selected for treatment. 4. Under fluoroscopy, the puncture needle tip is retracted to the ortho position on the medial edge of the pedicle, and the lateral position is located 1/3 to 1/4 of the posterior edge of the vertebral body. 5. Insert the plasma cutter head into the puncture trocar. The cutter head should be about 1 cm beyond the tip of the trocar. The tip of the cutter head and the end of the trocar are marked as the closest point of treatment. Then the plasma cutter head is placed. Insert it into the deepest point, make sure that the range of the disc is not exceeded, and then mark the farthest point at the end of the tip and the end of the trocar as the treatment point (move the spring card here to ensure that the knife is worn during treatment) To the disc). 6. Connect the cable cutter head to the main unit and adjust the power to 2nd gear. 7. Insert the cutter head from the nearest point to the farthest point by one rotation for 60° (the pedal ablation button when inserting, the pedal curling button when pulling, the time of insertion and extraction should be >4s) ), a total of 6 times. The removal of the cutter head and the puncture needle is completed. 8. If percutaneous laser internal decompression is used, insert the optical fiber into the puncture trocar, and make sure that the head of the optical fiber is located in the middle of the intervertebral disc under fluoroscopy, and adjust the power and time according to the requirements of the instrument for treatment. complication 1. Lumbar muscle spasm and pain: no matter what method is used, it can appear after surgery. Percutaneous puncture nucleus pulposus aspiration and percutaneous laser internal decompression are more common, usually relieved after 4 to 6 weeks. 2. Nerve root injury: Needle tip or casing injury and nerve root during puncture or treatment (when using laser internal decompression and nucleus pulposus) heat is transmitted through the needle to cause nerve root damage. 3. Endplate inflammation: caused by damage to the cartilage board during operation. Percutaneous puncture nucleus pulposus aspiration and percutaneous laser internal decompression are more common. 4. Discitis: due to aseptic inflammation caused by residual necrotic tissue in the intervertebral disc. 5. Intervertebral space infection: improper operation of aseptic, severe cases can lead to osteomyelitis of the vertebral body.

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