Technique:
The patient is positioned in the prone position, using a posterolateral approach under fluoroscopy; a 17-gauge needle is inserted through the skin into the center of the nucleus. A slightly curved spine wand is then advanced through the needle until the distal end of the tip touches the inside wall of the anterior annulus.
The depth gauge is then advanced down the shaft of the wand to the needle hub, representing the depth of wand advancement through the needle for creating channels within the nucleus from coblation. The wand is then withdrawn until the tip is inside the posterior wall of the annulus corresponding to the posterior boundary of the nucleus. The proximal depth gauge and the distal reference mark on the wand represent the working length of the wand for creating channels within that specific nucleus.
The wand is advanced and withdrawn at an approximate rate of 0.5 cm/s to create a single channel. This protocol is repeated to create six different channels by rotating the wand at 2 o’clock increments in either a clockwise or counterclockwise direction. The result is removal of nuclear material by creating multiple intradiscal channels during coblation with the wand.
The patient is complaining of sciatic pain for more than 6 months with no response to conservative treatment, with single or double level contained disc herniation. The procedure is performed in an outpatient setting. The treatment is done with local anesthesia along with IV sedation when needed. The patient is positioned in the prone position, using a posterolateral approach under fluoroscopy; a 17-gauge needle is inserted through the skin into the center of the nucleus. A slightly curved spine wand is then advanced through the needle until the distal end of the tip touches the inside wall of the anterior annulus. The wand is advanced and withdrawn at an approximate rate of 0.5 cm/s to create a single channel. This protocol is repeated to create six different channels by rotating the wand at 2 o’clock increments in either a clockwise or counterclockwise direction. The result is removal of nuclear material by creating multiple intradiscal channels during coblation with the wand. The needle was removed and puncture site was sterilized and covered.
