Principle of Plasma Disc Nucleus Ablation
Plasma disc nucleus pulposus ablation forms a thin layer of low-temperature plasma visible to the naked eye at the front of the treatment tip.
The charged particles in this thin layer have enough kinetic energy to interrupt the peptide tendons of large molecules in the tissue, causing them to break down into molecules and atoms of low molecular weight. (e.g., oxygen, nitrogen, etc.) and exits the body through the puncture channel, thus producing real-time, efficient and precise cutting and ablation principles.
When hemostasis and tissue tightening are required, the host generates the precise amount of heat needed by the physician to achieve hemostasis and tightening without damaging the surrounding tissue activity.
Plasma disc nucleus pulposus ablation procedure
After local skin disinfection, a puncture needle is inserted into the nucleus pulposus of the disc via the affected side under the guidance of X-ray equipment. The appropriate position of the needle in the disc is then determined by frontal, lateral and oblique X-ray images.
The plasma tip is inserted and the ablation function is used in the nucleus pulposus before the crush function is used for treatment. The tip is removed postoperatively and antibiotics or ozone therapy may be administered.
Features of plasma ablation and crinkling
The thin layer of low-temperature plasma formed at the front of the plasma tip is capable of precisely ablating the nucleus pulposus tissue. The temperature of ablation during treatment is only 53℃, and the temperature beyond 1mm of the tip surface is less than 43℃, which will not cause thermal damage to other surrounding tissues under proper operation. With the function of real-time ablation, the decompression effect can be shown intraoperatively. The operation time is short and the complications are few.
Indications and contraindications
Indications.
Cervical and lumbar disc herniation (the best indication is an inclusive type of herniation without calcification with an intact fibrous ring).
Contraindications.
Severe spinal stenosis.
Significant spinal space stenosis.
Those with previous surgical treatment of the corresponding segment.
Those whose systemic conditions do not allow it (infections, metabolic diseases, etc.).
Intervertebral foraminal R for lumbar disc herniation (visualization, minimally invasive, fast postoperative results, is a new technology that major hospitals have been competing to carry out in recent years.
Indications for minimally invasive spine surgery with intervertebral foraminal technology
Patients with disc herniation who choose to undergo minimally invasive surgery must exhibit signs and symptoms of nerve root compression and must meet the following conditions.
1. persistent or recurrent radicular pain.
2, radicular pain is more severe than lumbar pain. Patients with sub-moderate bulge who have more lumbar pain symptoms than leg pain may first undergo cryo-plasma meduloplasty.
3.Invalidated by strict conservative treatment. including the use of steroidal or non-steroidal anti-inflammatory pain medications, physical therapy, and occupational or condition training procedures, conservative treatment is recommended for at least 4-6 weeks, but immediate surgery is required if there is a progressive increase in neurological symptoms.
4. no history of substance abuse and psychological disorders
5. a positive straight leg raise test with difficulty bending.
6.In order to precisely determine the location and nature of the herniated or prolapsed nucleus pulposus, as well as the intervertebral foraminal osteophytes, a thorough imaging examination should be performed before surgery, especially CT and MRI are important tools to precisely determine the size, location and nature of the nucleus pulposus.
Fundamentals of the operation
The aim is to relieve pressure on the nerve roots and eliminate the pain caused by nerve compression by completely removing the herniated or prolapsed nucleus pulposus and hyperplastic bone in the safe triangle of the intervertebral foramen, outside the fibrous ring of the disc.
The procedure is performed through a minimally invasive spinal surgical system consisting of an intervertebral foraminoscope, corresponding surgical instruments, an imaging processing system, and a dual-frequency radiofrequency machine.
While the herniated or prolapsed nucleus pulposus is completely removed, osteophytes are removed, spinal stenosis is treated, and broken rings can be repaired using radiofrequency technology.
The surgical steps can be specifically divided into nine parts
Step 1: Preoperative preparation An MRI of the lumbar spine is required to understand the morphology of the herniation, and a DR of the lumbar spine to understand the height of the intervertebral foramen and iliac spine.
Step 2: marking the site of needle entry A general paracentral opening distance of between 11-14 cm and marking.
Step 3: local anesthesia.
Step 4: puncture and placement of the guidewire up to the disc
Step 5: discography staining the nucleus pulposus blue using a mixture of methylene blue and iodophoresis in a ratio of 1:4 injected in 1-2 ml to facilitate observation of the morphology and removal of the disc herniation
Step 6: Enlargement of the intervertebral foramen step by step with a grinding drill .
Step 7: Placement of the working trocar and intervertebral foramen.
Step 8: remove the stained herniated nucleus pulposus and explore; Step 9: apply bipolar radiofrequency to defibrillate the annulus.
Surgical approach selection
1, simple disc protrusion and partial prolapse type cases, the posterior lateral safety triangle approach is preferred.
2.The distal lateral horizontal approach is suitable for central giant herniation.
3.Posterior or interlaminar approach is suitable for free or calcified patients.
Comparison of intervertebral foraminoscopy technology with other orthopedic treatment methods
It is understood that this technique removes the herniated disc tissue under endoscopic surveillance through a special lateral foraminal approach, which is less invasive than the usual posterior approach. A typical laminectomy, in order to approach the target point, necessarily causes extensive damage to structures that play an important role in spinal stability, which usually requires immediate spinal fusion.
In contrast, the laminectomy technique gradually enlarges the intervertebral foramen with a patented reamer and appropriate medical instrumentation, completely removing any herniated or prolapsed fragments as well as the degenerated inflamed nucleus pulposus. It also provides continuous irrigation and anti-inflammatory treatment of the lesion, uses radiofrequency electrodes to repair the fibrous annulus, ablates nerve sensitizing tissue, blocks the annular nerve branches, and relieves the patient of soft tissue pain.