Welch William C, Gerszten Peter C
Department of Neurological Surgery and Orthopaedic Surgery, School of Rehabilitative Sciences, University of Pittsburgh Medical Center-Health System, Presbyterian University Hospital, Pittsburgh, Pennsylvania, USA.
Neurosurg Focus. 2002 Aug 15;13(2):E7. doi: 10.3171/foc.2002.13.2.8.
In recent years the general trend in spinal surgery has been one of reductionism and minimalization. A number of techniques have recently been developed that are applicable in the treatment of lumbar disc herniation and discogenic pain due to degenerative disc disease. The purpose of this manuscript is to examine two newer percutaneous disc treatment techniques, intradiscal electrothermal therapy (IDET) anuloplasty and nucleoplasty. The authors review the appropriate clinical treatment criteria, techniques, and lessons learned after performing these procedures in more than 100 patients. The IDET involves the percutaneous insertion of a specially designed thermal resistance probe followed by controlled heating of the intervertebral disc. This may result in disc shrinkage and reduction in pain. The nucleoplasty procedure involves the percutaneous removal of disc material by using a low-temperature resister probe to disintegrate and evacuate disc material, followed by thermal treatment of adjacent residual disc material. To date, no study has been published in which investigators examine the outcomes of this procedure for the treatment of radicular leg pain and low-back pain. Both IDET and nucleoplasty appear to be safe procedures. The IDET procedure may be an alternative to lumbar interbody fusion. Although its long-term role is being defined, this technique appears to provide intermediate-term relief of pain in a population of patients with discogenic low-back pain. Nucleoplasty may provide a percutaneous alternative to microdiscectomy in selected cases.
近年来，脊柱外科的总体趋势是还原论和微创化。最近已开发出多种技术，可用于治疗腰椎间盘突出症和因椎间盘退变疾病引起的盘源性疼痛。本手稿的目的是研究两种较新的经皮椎间盘治疗技术，即椎间盘内电热疗法（IDET）环形修补术和髓核成形术。作者回顾了在100多名患者中实施这些手术后的适当临床治疗标准、技术及经验教训。IDET包括经皮插入一个特别设计的热阻探头，随后对椎间盘进行可控加热。这可能会导致椎间盘收缩并减轻疼痛。髓核成形术包括使用低温电阻探头经皮去除椎间盘物质，以分解并清除椎间盘物质，随后对相邻的残余椎间盘物质进行热处理。迄今为止，尚未发表过研究人员检查该手术治疗腿部放射性疼痛和下腰痛疗效的相关研究。IDET和髓核成形术似乎都是安全的手术。IDET手术可能是腰椎椎间融合术的一种替代方法。尽管其长期作用仍在确定中，但该技术似乎能为患有盘源性下腰痛人群提供中期疼痛缓解。在某些特定病例中，髓核成形术可能为显微椎间盘切除术提供一种经皮替代方法。
