Percutaneous plasma laser disc coagulation and navigable ablation decompression in the treatment of cervical disc herniation: a single center experience

Use of Navigable Ablation Decompression Treatment (L-DISQ) for Contained Cervical Disc Herniation - Technical Note and Literature Review

Introduction

A new navigable percutaneous disc decompressor (L'DISQ-C, U&I Co., Uijeongbu, Korea), introduced in 2012, is designed to allow direct access to herniated disc material. The L'DISQ device can be curved by rotating a control wheel, directed into disc herniation treats, and decompresses contained herniated discs with minimal collateral thermal damage. This study reports the case of contained central disc herniation in a 34-year-old male with a 2-year follow-up successfully treated with navigable ablation decompression treatment (L-DISQ).

Case Report

A 34-year-old man presented to the outpatient department with a 6-month history of neck pain and bilateral upper limb radiation. His neck pain had increased progressively. At the time of presentation, his neck pain visual analog scale score was 7/10, and his neck disability index score was 30. The magnetic resonance images showed a single fluid-containing lesion with a hyperintense zone at the C4-5 levels with central disc herniation. The patient was successfully treated with the navigable ablation decompression treatment (L-DISQ) procedure.

Conclusion

The navigable ablation decompression treatment (L-DISQ) is a valuable technique in treating contained cervical disc herniation with rapid pain relief and improvements in functional outcomes without any significant injury to surrounding structures. It is safe, precise, and effective in the treatment of symptomatic cervical disc herniations. Large, randomized, and multicenter trials are needed to explore the potential of the same technique further.

[Percutaneous endoscopic Key-Hole technology for treatment of paracentral cervical disc herniation]

OBJECTIVE

To investigate the effectiveness of percutaneous endoscopic posterior cervical Key-Hole fenestration decompression and nucleus pulposus extirpation in the treatment of paracentral cervical disc herniation.

METHODS

Between December 2015 and October 2018, 29 cases of paracentral cervical disc herniation were treated with percutaneous endoscopic posterior cervical Key-Hole fenestration decompression and nucleus pulposus extirpation. There were 16 males and 13 females, with an average age of 49.7 years (range, 39-78 years). The disease duration was 3.5-15.0 months (mean, 6.2 months). The herniated disc located at C 3, 4 in 2 cases, C 4, 5 in 5 cases, C 5, 6 in 9 cases, C 6, 7 in 12 cases, and C 7, T 1 in 1 case. The main symptoms were radiculopathy symptom. The operation time, intraoperative blood loss, hospital stay, and complications were observed and recorded. Visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, cervical range of motion (ROM), Macnab standard, and cervical segment stability were used to evaluate the efficacy and safety of the operation.

RESULTS

All patients were followed up 11-43 months, with an average of 19.4 months. The operation time was 67-89 minutes (mean, 73.3 minutes); the intraoperative blood loss was 18-30 mL (mean, 22.9 mL); the hospital stay was 5-10 days (mean, 7.3 days). All the incisions healed by first intention. There was 1 case of hypodynia and hyperalgesia in the affected limb after operation,1 case of decreased limb muscle strength. The VAS scores and JOA scores at each time point after operation were superior to those before operation ( P<0.05). There was no significant difference between the time points after operation ( P>0.05). At last follow-up, the effectiveness was rated according to the Macnab standard as excellent in 11 cases, good in 15 cases, fair in 2 cases, and bad in 1 case, with an excellent and good rate of 89.7%. The CT and MRI showed the decompression of spinal canal and nerve canal. There was no significant difference in cervical ROM between pre- and post-operation ( t=1.427, P=0.165), and no surgical segment instability occurred by X-ray films of flexion and extension of cervical vertebrae.

CONCLUSION

For the paracentral cervical disc herniation with simultaneous compression of nerve roots and spinal cord, percutaneous endoscopic posterior cervical Key-Hole fenestration decompression and nucleus pulposus extirpation has the advantages of small trauma, quick recovery, and satisfactory effectiveness, and can be used as a safe and effective minimally invasive procedure.