Clinical manifestation and treatment strategy of intervertebral space infection after radiofrequency ablation of lumbar nucleus pulposus / 中国骨伤

OBJECTIVE@#To study the clinical manifestations and treatment of intervertebral space infection after percutaneous lumbar radiofrequency ablation of nucleus pulposus.@*METHODS@#A retrospective analysis was performed of 496 patients who underwent percutaneous lumbar disc decompression using low-temperature plasma radiofrequency ablation nucleus pulposus from June 2009 to June 2019. Six patients had lumbar infection, and the infection rate was 1.21%. All patients were male, ranging in age from 20 to 61 years old. Three patients underwent single segment radiofrequency ablation, two patients underwent dual segments ablation;and one patient underwent three segment ablation, totaling 10 intervertebral discs. One patient was complicated with type 2 diabetes before operation. The interval between infection occurrence ranged from 21 to 65 days.@*RESULTS@#All 6 patients were followed up, and the duration ranged from 18 to 40 months, with an average of 24 months. Among them, 2 patients presented with symptoms of low back pain accompanied by fever, and imaging examination showed intervertebral space infection accompanied by abscess. In addition, 4 patients experienced low back pain but no fever, and MRI showed abnormal signals of the infected intervertebral endplate or vertebral body. One patient showed staphylococcus aureus in blood culture, while the remaining 5 patients showed negative bacterial culture. All the patients were treated with antibiotics after diagnosis. Four patients were treated with conservative management to control infection;1 patient was treated with debridement of posterior lumbar infection focus, and 1 patient was treated with debridement of posterior lumbar infection focus combined with interbody fusion and internal fixation.@*CONCLUSION@#The occurrence of intervertebral space infection during lumbar radiofrequency ablation nucleoplasty should be given sufficient attention. Strict aseptic technique, avoiding repeated multi segment puncture, realizing early detection and treatment, and selecting appropriate treatment methods according to the severity of infection is the guarantee of achieving curative effect.

Percutaneous Discectomy of Herniated Intervertebral Disc with a Dekompressor(R) / 대한통증학회지

BACKGROUND: Radicular pain, associated with herniated intervertebral disc, has been treated with either conservative treatments or a traditional surgical discectomy. Several modalities for minimally invasive percutaneous procedures have been developed as alternatives to a surgical discectomy. Percutaneous decompression using a Dekompressor(R) probe has been recently introduced. Herein, we report the outcome of percutaneous decompression with a Dekompressor(R) for the treatment of a herniated intervertebral disc. METHODS: Between August 2004 and April 2005, percutaneous decompression was performed using a Dekompressor(R), 1.5-mm percutaneous lumbar discectomy probe in 17 patients with a herniated lumbar intervertebral disc resistant to conservative treatments, with the results reviewed retrospectively. The procedure was performed under fluoroscopic guidance after local anesthesia. Disc access was gained with a posterolateral approach on the symptomatic side and intradiscal placement of the discectomy probe in the herniated disc confirmed from the anteroposterior and lateral views on the fluoroscopy. RESULTS: We obtained satisfactory clinical results in 14 patients with a decrease in the initial Visual analogue scale (VAS) of more than 55% and the elimination or reduction of analgesic medication, with a follow-up of 3 to 11 months. CONCLUSION: We concluded that a percutaneous discectomy with a Dekompressor(R) probe might be an effective alternative for the treatments of painful disc herniations resistant to conservative managements when performed under proper selection criteria.

Percutaneous Cervical Discectomy Using Dekompressor(R): A case report / 대한통증학회지

Cervical radicular pain has been recognized as a common cause of neck, shoulder and arm pain. The initial recommended therapy is based on the medical treatment by anti-inflammatory, analgesic agents, rest, traction and physical therapy. In the case of failure with these therapies, the classical alternative is a surgical discectomy, but this is associated with numerous risks inherent to invasive procedures. As a result, a number of percutaneous intradiscal therapies have developed over the last 3 decades, which have specifically focused on the pathology of the disc. However, these treatments have considerable limitations and success rates, and none allow for the extraction of a quantifiable amount of nucleus pulposus via a 17 gauge introducer using fluoroscopic guidance alone. Herein, we describe our experience using a Dekompressor(R) on a 52 year-old female patient with a cervical disc herniation. Percutaneous decompression in the treatment of cervical disc herniation was successfully performed, with a good outcome.

Percutaneous Decompression in the carpal Tunnel Syndrome / 대한정형외과학회잡지

Carpal tunnel syndrome is the most common peripheral nerve entrapment syndrome due to compression of the median nerve at the wrist. Division of the transverse carpal ligament for median nerve compression in patients with carpal tunnel syndrome is a common and successful procedure. A variety procedures exist to release the transverse carpal ligament the classic open release, limmited open or percutaneous release, and endoscopic release. From February 1994 to January 1996, 39 carpal tunnel releases were performed by percutaneous method in 30 patients (3 males and 27 females) at the Chonnam University Hospital. The patients age ranged from 42 to 67 years (average 54.8 years). The duration of the symptoms ranged from 3 months to 10 years. According to Brown's outcome analysis, results were as follows. 1. Persistent pain and paresthesia were noted in only 3 cases (7.7%) at 24 week postoperatively. 2. Two-Point discrimination on the index finger was improved significantly at 12 week postoperatively (p<0.05). In electromyographic study, conduction delay of motor and sensory fibers was diminished significantly at 4 week postoperatively (p<0.05). 3. Functional outcomes (grip strength, pinch strength, scar tenderness and return to work) were showed good and excellent result. We concluded that percutaneous decompression is one of the less morbid method for decompressing the carpal canal and relief of symptoms for the patient.