Plasma radiofrequency ablation, also known as low-temperature plasma therapy (Temperature-controlled Radiofrequency, TCRF), is the use of low-temperature plasma radiofrequency energy, with a lower temperature (about 40-70 degrees) to carry out tissue removal, thereby reducing tissue damage, and can greatly reduce the patient’s pain and shorten the recovery cycle.
Plasma radiofrequency disc ablation is a medical instrument developed by the U.S. military technology and belongs to the fourth generation of physical therapy technology, which began to develop rapidly in clinical treatment only after the U.S. FDA approved it in 1999. ARTHROCARE invented and patented the “plasma” technology – COBLATION, that is, the specific 100KHz ultra-low frequency electrical energy excitation medium (Nacl) to generate plasma, in the temperature range of 40 ~ 70 ℃ protein reversible denaturation, by The sound waves generated by “plasma” interrupt the molecular bonds and directly cleave proteins and other biological macromolecules into O2, CO2, N2 and other gases, thus completing a variety of functions such as tissue ablation, cutting, perforation, crumpling and hemostasis at the cost of “minimally invasive”. It has been approved by UL of North America, CE of Europe and ISO9001, and the FDA of USA and the State Food and Drug Administration of China have approved the clinical application of this technology.
I. Surgical method.
The surgery is performed by inserting a needle into the intervertebral disc under the guidance of C-arm X-ray, using radiofrequency energy inside the nucleus pulposus of the disc to vaporize multiple channels in the disc through molecular decomposition under low temperature, reducing the pressure inside the disc, thus relieving pain and reducing the irritation of the nerve roots by the disc tissue, and then closed with thermal coagulation after the surgery. The procedure causes minimal damage to the adjacent tissues and there is no concern for thermal injury. The procedure is minimally invasive without scarring, simple to perform, and does not affect the stability of the spine.
Features.
①Surface tissue temperature 40-70℃
②Tissue targeted ablation through intermolecular separation
③Minimal indirect tissue damage
④Minimal heat penetration
II. Treatment advantages.
1, high safety: plasma working temperature at 40-70 degrees, low-temperature safety, no incision, small trauma, maximum protection of the fibrous ring wall, can effectively remove the tissue; postoperative degeneration of the disc caused by small, small impact on the stability of the spine;
2, more rapid: short treatment time, fast recovery;
3, lower charges: compared with the traditional open surgery tens of thousands of dollars, the surgery significantly reduced the hospitalization costs of patients.
Third, cervical spondylosis indications:
1, chronic dizziness and nausea, heavy neck and shoulders, pain with radicular soreness and burning pain in the upper limbs, non-spinal cervical spondylosis patients with MRI confirmed corresponding interstitial disc herniation.
2.Patients who are diagnosed with cervical disc herniation and whose non-surgical treatment is ineffective.
3.Cervical discogenic cervical spondylosis, inclusion cervical disc herniation or focal herniation compressing cervical nerve root causing radicular pain or neck pain, corresponding to the lesioned disc, that is, consistent with the clinical symptoms, the fibrous ring does not see obvious rupture.
4, the disc protrusion does not exceed 4 mm, and the volume of the spinal canal is not less than 4/5.
5, not accompanied by spinal stenosis, and exclude spinal fractures, tumors, intervertebral foraminal stenosis or intervertebral joint ankylosis caused by collapse of the intervertebral space.
IV. Indications for lumbar spondylolisthesis.
1.Continuous lower back pain, the duration of the disease for more than 6 months.
2.Ineffective conservative treatment for more than 6 months.
3.No positive signs found on neurological examination.
4, Negative straight leg raise test.
5.No nerve compression on MR.
6, Intervertebral discography of the diseased space shows that it is able to successfully replicate low back pain that matches the clinical presentation under conditions of very low increase in intradiscal pressure. A two-segment contrast test should be available.
V. Contraindications.
1, Low back pain due to non-spinal pathology.
2. Those who have undergone surgical treatment in the corresponding segment.
3.The systemic condition does not allow.
4.Disc prolapse, free nucleus pulposus, lateral saphenous stenosis, and narrowing of the intervertebral space.
5.Discography of the diseased intervertebral space cannot replicate the manifestation of lower back pain.
The effect of stability Radiofrequency ablation myeloplasty only partially removes the nucleus pulposus, which has little effect on the height of the vertebral body and does not cause damage to the vertebral body, small joints, ligaments and other structures. The protruding part of the disc can be returned to the stability of the cervical spine, and will not accelerate the degeneration of the adjacent segments, so it has no significant effect on the stability of the cervical spine. It is possible to get down to the floor early and resume normal work.
Typical case: Female, 71 years old, was admitted to the hospital with “neck and shoulder pain and discomfort for 1 month, aggravated with right upper extremity pain for 10 days”. The patient’s quality of life was seriously affected. The patient had a history of coronary heart disease, hypertension for more than 20 years, diabetes mellitus for 1 year, and rheumatoid arthritis for 5 years. MRI and CT of the cervical spine both showed that the C3/4 and C4/5 discs were herniated to the right posteriorly, and the corresponding dural sac was compressed. The diagnosis was confirmed as: cervical spondylosis (mixed type, cervical + nerve root type, C3/4, C4/5, JOA score of 17, VAS score: 7), which was poorly treated with conservative therapy.
The patient underwent radiofrequency ablation of the C3/4 and C4/5 disc nuclei by percutaneous percutaneous plasma under local anesthesia. The procedure went smoothly and took about 30 minutes, and the patient felt a significant reduction in neck pain and right upper extremity radiating pain immediately after the procedure, and mobility improved significantly, with a VAS score of 3. The patient felt good about himself and was discharged after 1 day of observation in the ward.