Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
Department of Orthopedics, Superspeciality Hospital, Ahmedabad, India.
Pain Physician. 2022 Oct;25(7):E1073-E1079.
Various minimally invasive procedures for treating discogenic pain have been reported in recent years. A Disc-FX® system can be used to perform nucleus pulposus (NP) removal, radiofrequency ablation, and annuloplasty under the guidance of x-ray fluoroscopy. However, when a probe tip with focused heat is placed on the intradiscal/subannular area to perform nucleo-annuloplasty using radiofrequency lesioning, thermal injury to the spinal cord or spinal nerves is a concern.
To assess the thermal profile generated by the Disc-FX ablation and modulation system in intervertebral discs from human cadaveric spine sections and evaluate the safety of its thermal dispersion function.
A cadaveric study.
NP ablation and annulus fibrosus modulation were performed on a fresh human cadaveric lumbar spine intervertebral disc in a 36.5°C circulating water bath using radiofrequency. The 4 points from the center of the disc to one-third, two-thirds and the outer layer of the annulus were divided into 4 points, A-D, respectively, and radiofrequency lesions were performed on the 4 points.
The temperature was increased upon irradiation. It fell slowly with the cessation of irradiation. The temperature was not significantly different between Turbo and Hemo mode at each point. The temperature was not significantly different among the 4 points at each mode. The average temperature of the ventral side of the dura mater was kept below 37°C.
The results of this study are limited due to the use of a cadaveric spine, which could not reflect the effect of soft tissue such as muscles and connective tissue around the disc. The position of the temperature measuring probe was relatively fixed. This cadaver demonstration was conducted at the L4-L5 level, which is mostly not restricted by the height of the iliac crest. CONCLUSIONS: When performing NP ablation and annular modification, the epidural peripheral temperature should always be kept below 37°C. This preliminary in vitro research using human cadaveric discs showed that radiofrequency maintained the epidural space at a safe temperature during nucleo-annuloplasty.
近年来，各种微创治疗椎间盘源性疼痛的方法相继报道。Disc-FX®系统可在 X 射线透视引导下进行髓核切除、射频消融和环成形术。然而，当使用带有聚焦热探头的探针放置在椎间盘内/环下区域，通过射频消融进行核-环成形术时，脊髓或脊神经热损伤是一个关注问题。
评估 Disc-FX 消融和调制系统在人尸体脊柱节段椎间盘内产生的热分布，并评估其热分散功能的安全性。
尸体研究。
在 36.5°C 循环水浴中使用射频对新鲜人尸体腰椎间盘进行 NP 消融和纤维环调制。将椎间盘中心到 1/3、2/3 和纤维环外层的 4 点分别标记为 A、B、C、D 点，在 4 点进行射频消融。
照射后温度升高，照射停止后缓慢下降。在每个点，Turbo 模式和 Hemo 模式的温度没有显著差异。在每个模式下，4 个点之间的温度没有显著差异。硬脑膜腹侧的平均温度保持在 37°C 以下。
由于使用了尸体脊柱，本研究结果受到限制，无法反映椎间盘周围肌肉和结缔组织等软组织的效果。温度测量探头的位置相对固定。这项尸体演示是在 L4-L5 水平进行的，该水平受髂嵴高度的限制较小。
在进行 NP 消融和环修改时，硬膜外周围温度应始终保持在 37°C 以下。本研究采用人尸体椎间盘进行的初步体外研究表明，射频在核-环成形术中可将硬膜外间隙维持在安全温度。
