Plasma Radio-Frequency-Based Diskectomy for Treatment of Cervical Herniated Nucleus Pulposus: Feasibility, Safety, and Preliminary Clinical Results

• Published in: American Journal of Neuroradiology Vol. 27; no. 10; pp. 2104 - 2111
• Main Authors: Bonaldi, G, Baruzzi, F, Facchinetti, A, Fachinetti, P, Lunghi, S
• Format: Journal Article
• Language: English
• Published: Oak Brook, IL Am Soc Neuroradiology 01-11-2006; American Society of Neuroradiology
• Subjects: Adult; Biological and medical sciences; Catheter Ablation - adverse effects; Cervical Vertebrae; Diskectomy - adverse effects; Diskectomy - methods; Feasibility Studies; Female; Fundamental and applied biological sciences. Psychology; Humans; Intervertebral Disc Displacement - surgery; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Nervous system; Nervous system involvement in other diseases. Miscellaneous; Neurology; Prospective Studies; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Somesthesis and somesthetic pathways (proprioception, exteroception, nociception); interoception; electrolocation. Sensory receptors; Spine; Vertebrates: nervous system and sense organs; Nervous system diseases; Feasibility; Treatment; Nucleus pulposus; Safety; Radiodiagnosis
• ISSN: 0195-6108; 1936-959X; 1432-1920

Several techniques, including chymopapain, mechanical aspiration, laser-based disk decompression, and endoscopic keyhole surgery, have been proposed as minimally invasive alternatives to fusion for treating cervical disk herniation, though none has gained wide acceptance. The purpose of this study was to assess feasibility, safety, and preliminary clinical results of percutaneous plasma-mediated radio-frequency-based diskectomy for cervical disk herniation.
Patients (N = 55) with cervical soft disk protrusion were treated over a 29-month period. They had radicular pain; 3 patients also had moderate myelopathy. The procedure was performed with the Perc-DC SpineWand by using an anterior approach. Most cases were conducted with local anesthetic on an outpatient basis. Clinical outcomes were graded by using the Macnab criteria.
At 2 months, outcomes were good or excellent in 44/55 (80%) patients; the success rate was similar at 6 months, when 44 (85%) patients (n = 52/55) had good or excellent results. One clinically relevant complication (infectious diskitis) occurred within the first month postprocedure and was successfully treated. One technical complication (in situ rupture of the device tip) was observed; however, the patient remained asymptomatic during the 2-year follow-up. The 3 patients with clinical myelopathy experienced regression of cord compression symptoms; MR imaging in 2 patients showed morphologic evidence of reduction of cord compression.
Plasma radio-frequency-based diskectomy in the cervical spine appears to be a minimally invasive low-risk approach, which is easy to perform, associated with only minimal discomfort to the patient, and effective in the short term.