Application of plasma radiofrequency ablation technology in the treatment of spinal disorders
I. Mechanism of action
Radiofrequency technology is guided by percutaneous fluoroscopy throughout the whole process, through the special bipolar radiofrequency vaporization rod in the intervertebral disc, radiofrequency energy (125Vrms) is sent through the plasma tip at the tip of the rod, and at a lower temperature (about 50℃), a uniform thin layer of plasma is produced at the tip of the rod, and the charged particles in it gain enough kinetic energy to obtain acceleration, which breaks the organic molecular bonds of the nucleus pulposus tissue, thus vaporizing part of the The nucleus pulposus tissue is vaporized to form an efficient and precise vaporization and melting effect, and the macromolecules are broken down into elemental molecules and low molecular gases (oxygen, nitrogen, hydrogen, carbon dioxide) by cold melting. Then, with the aid of thermal coagulation technology, the spiral structure of collagen molecules is contracted by heating to about 70°C, which further reduces the volume of the nucleus pulposus and achieves decompression and decompression of the dura and nerve roots for treatment purposes.
Second, the surgery is performed by inserting a needle into the intervertebral disc under the guidance of C-arm X-ray and using radiofrequency energy inside the nucleus pulposus of the disc to vaporize multiple channels in the disc through molecular decomposition under low temperature to reduce the pressure inside the disc, thus relieving pain and reducing the irritation of the disc tissue on the nerve roots, 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, does not leave scars, is simple to perform, and does not affect the stability of the spine.
Third, the characteristics of plasma ablation medullary nucleus decompression.
1, treatment trauma is small, under the real-time monitoring of X-ray fluoroscopy, only a small incision of 1cm in the skin of the puncture entry point, percutaneous puncture and insertion of the puncture needle can complete the treatment. It can effectively release the compression on the nerve and also protect the intervertebral disc fiber ring and surrounding tissues from being destroyed. Unlike the previous heat contraction technology that causes tissue necrosis through high temperature, the system can precisely control the temperature of the blade at 50-60℃ in the wrinkle gear, so it has high safety.
2, the efficacy is sure: generally after treatment can relieve and eliminate clinical symptoms such as back and leg pain in a short time.
IV. Selection of cases (indications)
1.The patient’s age should not exceed 50 years, and the duration of the disease should not exceed 5 years.
2.Ineffective conservative treatment or poor efficacy, and not suitable for open surgery.
3.Lumbar pain with radiating pain, soreness and numbness in the buttocks or lower limbs after prolonged sitting or standing.
4, no significant reduction in disc height
5, MRI diagnosis of inclusive disc bulge or herniation.
6.Persons with positive intervertebral discography.
V. The following cases are not suitable for ion ablation nucleus pulposus decompression angioplasty
1, there is a significant reduction in disc height.
2, significant rupture of the intervertebral disc annulus fibrosus and overflow of the nucleus pulposus
3, moderate and severe spinal stenosis.
4, spinal fractures or tumors.
5, those with manifestations of infection.
VI. Postoperative treatment
1, bed rest for 3-7 days.
2, depending on the condition of oral anti-inflammatory and pain-relieving drugs.
3, with physical therapy, body therapy.
4.Wearing neck brace or waist brace for 4-6 weeks.
Catheter radiofrequency ablation
I. Mechanism of action
The radio frequency instrument sends out high frequency radio current, and the radio frequency current generates changing magnetic field at the tip of the working electrode, so that the molecular movement in the target tissue covered by the magnetic field generates heat, and thermal coagulation destroys the target area tissue; selective thermal coagulation destroys the nociceptive fiber conduction branch, then blocks the conduction of pain signal to the superior nerve and destroys the pain conduction pathway, so as to achieve the purpose of healing pain.
Indications
1.Radiation pain of lower limbs.
2.Basic diseases: lumbar disc herniation, lumbar spinal stenosis, lumbar postoperative pain syndrome, 1st degree vertebral body slippage, vertebral metastases.
3.The scope of the patient’s pain is consistent with the medical history, physical signs and imaging examination.
4. Elderly patients and patients with medical comorbidities are more advantageous.
III. Contraindications
1, coagulation dysfunction (INR>1.5 or platelet count <50,000/mm3).
2, Pregnant women (radiation teratogenesis).
3. Systemic infection or skin infection at the puncture site.
4.Persons with severe allergic reactions to any of the components of the injection.
5, have received the maximum dose of glucocorticoids for a period of time.
6, cauda equina syndrome, significant decrease in muscle strength of the lower extremities, huge interdiscal herniation, etc.
IV. Advantages of catheter radiofrequency technology in minimally invasive interventional treatment
1.Radiofrequency thermal coagulation treatment of all pain is to use its unique nerve localization function to find the sensory nerve and destroy the sensory nerve that conducts or mediates the lesion abnormality, thus providing one-time analgesia.
2. The advantages of RF thermal coagulation technology are no bleeding, no infection, no damage to motor nerve, accurate treatment site, minimal pain, nearly 100% efficacy, no recurrence after healing, risk factor close to zero, good economic and social benefits.
V. Postoperative treatment
1.Someone should support to go down within 12 hours after surgery
2, 1 week to avoid increasing the amount of activity, continuous sitting and standing no more than half an hour
3. Postoperative treatment can be combined with physical therapy and medication.