Percutaneous disk decompression (PDD) using a plasma-mediated, radiofrequency-based device has been found to produce good results for at least two years after the procedure.
Results from a study of more than 900 patients who underwent the procedure were highlighted in a poster session presented in Washington, DC, at the American Academy of Pain Medicine 27th Annual Meeting..
Sebastian Gitter, MD, a neurosurgeon at the Nova Clinic in Biberach, Germany, was the principal author of the study. "[PDD], with the aid of this device, is an exceptional treatment alternative," he said. In the series of patients included, roughly 78% reported good to very good results.
This type of PDD, known as nucleoplasty, was first developed about ten years ago, Dr. Gitter explained. "We started very early in the last decade by treating chronic lumbar back pain and radicular pain syndromes caused by disk degeneration. Presently, it's one of the most minimally invasive treatment procedures designed to decrease intradiskal pressure in cases of nonsequestered disk cannulations–disk protrusions," he said.
The procedure uses a plasma-based technology to remove tissue from the center of disks. During the surgical procedure, fluoroscopic guidance is used to insert an introducer needle into the nucleus/annulus junction. Then, a special surgical wand is passed through the passageway and into the nucleus of the disk.
With the use of a plasma-based technology (Coblation; ArthroCare Corporation), tissue is removed by creating channels. The technology ablates tissue using temperatures between 40°C to 70°C, so thermal damage surrounding the procedure is minimized.
Once sufficient tissue is cleared to accomplish decompression, surgical instruments are withdrawn and the surgical wound is bandaged. The procedure takes about 30 minutes.
In his study, Dr. Gitter presented two-year follow-up results on 922 patients who presented with chronic radicular pain and underwent PDD using the plasma-mediated technology. About a quarter of the patients were younger than 40 years, a little more than half were 40 to 50 years of age, and the remainder were older than 50 years.
Clinical data were collected from all patients preoperatively, then at two weeks, six months, one year, and two years after treatment.
Outcomes measures included the visual analog scale (VAS) to assess the presence and degree of leg and back pain and the use of medications. The Oswestry low back pain disability questionnaire was also administered to all patients.
Before surgery all the patients reported a pain score on the VAS of greater than six, and all were taking nonsteroidal anti-inflammatory medications or opiates for their pain. Baseline Oswestry scores classified 21% of patients as moderately disabled, 65% as severely disabled, and 14% as crippled.
At two weeks after surgery, 83% of patients reported no leg pain and 86% reported no back pain. Nearly three-quarters of patients had ceased to take pain medications, and 80% had Oswestry pain scores equal to or less than 20%, indicating minimal disability.
At six-month follow-up, 98% of patients reported no leg pain and 95% reported no back pain, 98% were not taking pain medications, and 93% had Oswestry scores of less than 20%.
In about 4% of cases the surgery was deemed to have been unsuccessful. About half of those patients later underwent open surgery.
Some adverse effects were associated with the plasma-based procedure. About three-quarters of patients reported soreness at the needle insertion site, a quarter reported numbness and tingling that wasn't present before the procedure, about 15% say they experienced increased intensity of pain compared with before the procedure, and another 15% say they have pain in a different location than they did before the surgery.
Dr. Gitter has continued to evaluate the efficacy and safety of the procedure and said he now has results extending up to eight years postoperatively in about 2000 patients. "The failure rate is a bit higher, up to 7% in some subgroups, but we're also getting continuous pain relief in about 76% of patients," he said.
Dr. Gitter has disclosed no relevant financial relationships.
American Academy of Pain Medicine (AAPM) 27th Annual Meeting: Poster 218. Presented March 26, 2011.
Steven Fox • Medscape Medical News © 2011 WebMD, LLC