Interventional Procedures : intervertebral Disk

Percutaneous Interventional Procedures : intervertebral Disk

Back and leg pain is actually the number one cause of health care expenditures in the US afflicting nearly eight million people at an estimated impact of $200 Billion a year. This pain may be caused by disruption of the intervertebral disk that has been treated traditionally through open dissection of soft tissue and bone (e.g. diskectomy and fusion). Surgical diskectomy has achieved reliable and favorable outcomes by reducing pressure within the intervertebral disk and its influence on the adjacent nerve root.

Despite its acceptance, open diskectomy is a major surgical procedure with reported complications due to its invasive nature. Ramirez and Thisted reviewed 28,000 diskectomy procedures with 1 in 64 patients having a major complication, 1 in 335 having a neurological complication, nearly 1 in 500 having a cardiovascular complication and 1 in 1,700 dying from the procedure. To improve the risk benefit ratio of procedures performed for spinal pain, an evolution of minimally invasive techniques has occurred. Minimally invasive diskectomy began with Hijaka’s report of percutaneous nucleotomy using a prototype cutter in 1973. Onik reported his experience with the Nucleotome device in 1985. Choy presented clinical results using the PLDD Percutaneous Laser Diskectomy in 1987. Annuloplasty was introduced in 1997 by Saal, its effectiveness although remains actually controversial. Radiofrequency disk decompression or disk nucleoplasty procedure was applied first in july 2000. Numerous percutaneous diskectomy clinical studies have been reported in many peer-reviewed journals over the past three decades demonstrating its effectiveness and low complication rates of such techniques.

The minimally invasive procedures of the disk performed by interventional radiologists in our department are:

• Disk biopsy and drainage
• Diskography
• Periradicular steroid infiltration
• Annuloplasty or Intradiskal Electrothermal Annuloplasty IDET®
  • Movie 1 : principle
  • Movie 2 : cases
• Percutaneous Laser Disk Decompression PLDD
• Nucleoplasty or Percutaneous Radiofrequency Disk Decompression
  • Movie case 1

Conclusion

Radiologists are already involved in many percutaneous diagnostic minimally invasive procedures in disk diseases including discography, and disk biopsy.

The success of radiologists in this field is well accepted and we have removed the need for many surgical diagnostic and therapeutic procedures. This success is related to our knowledge of the anatomy, pathology, and imaging and to our skills to perform procedures percutaneously under exclusive fluoroscopy or CT guidance. Therefore the radiologists are involved in many different procedures including diskal biopsy, abscess localization and drainage, percutaneous infiltration of steroid, percutaneous nucleotomy, and annuloplasty. The majority of these procedures are performed on an outpatient basis.