Percutaneous Lumbar Disc Radiofrequency Intervention-With a Review of Newer Lumbar Disc Steerable Plasma Coblation Devices

Author(s): Dr Rajendra Tiruchelvarayan

Background:

Lumbar disc disease and prolapsed intervertebral discs(PID) are common conditions. They cause debilitating lower back pain, sciatica. Proven surgical treatments includes lumbar microdiscectomy. However, this comes with effects of muscular, soft tissue disruption, and the potential surgical complications. Recently, interventional devices utilising thermal heating energy(eg. IDET®), and radiofrequency plasma coblation nucleoplasty have been introduced. Since 1999, a straight cannula needle probe nucleoplasty device(Nucleoplasty®) has been introduced. Newer navigable decompression device options(eg. Yesdisc®) can directly treat contained disc herniations, and discogenic pain. The RF Coblation tip can be directed accurately to the actual damaged disc site, for targeted decompression.

Objectives:

To compare the different percutaneous lumbar disc radiofrequency devices and their efficacy. We also assess if the newer navigable plasma coblation devices are more effective.

Methods:

In our article, we searched PubMed and Medline for relevant studies on Percutaneous Lumbar Disc Thermal Ablation, RF Devices for lower back pain. We searched for studies on the efficacy of newer Navigable Coblation Devices. We also reviewed our personal experience with the above devices. The primary outcome measures were improvement in Visual Analogue Scores(VAS) by 50% at 6 months duration or more. Other indices included the Owestri Disability Index(ODI).

Study Results and Discussion:

In the treatment of discogenic pain treatment, devices such as IDET® and Biacuplasty® have shown modest improvement results in pain relief. The improvement in VAS ranges from 40% to 57%. For the IDET procedure, cases of complications such as catheter shearing were found to have have occurred. Percutaneous laser disc decompression shows promising results, ranging from 60-70% improvement in 6 month VAS scores. This procedure requires care, as cases of thermal injury to the vertebral end-plates have been reported. For nucleoplasty devices(which can treat both a herniated disc and discogenic pain), we find the results of navigable coblation devices(eg.Yesdisc and L’Disq) were better(VAS improvement ranging from 68.5% to 88%), when compared to the older straight cannula nucleoplasty device(VAS improvement ranging from 53-60% at 12 months). These results are also demonstrated in the author’s personal intervention series of 61 procedures. The incidence of complications such as discitis, neural damage were low(less than 1%).

Conclusion:

Percutaneous lumbar disc RF intervention has an important role in managing persistent lower back pain. A variety of intervention devices have been introduced. Thermal RF ablation of the annular pain fibres has been shown to be moderately effective in improving discogenic pain. For contained disc herniations, lumbar disc plasma coblation using navigable devices such as Yesdisc® show promising results. Encouraging VAS results are shown, ranging from 70% to 88%, with low procedural risks. This should be considered a good treatment option in selected cases. Further larger scale studies are needed in the future to assess this.