The annuloplasty is a minimally invasive procedure for managing chronic discogenic back pain in patients who have failed conservative treatment, and who otherwise are possible candidates for spinal fusion. The procedure might relieve discogenic pain through numerous potential mechanisms, including thermal nociceptive fiber destruction, biochemical mediation of inflammation, cauterization of vascular ingrowth, and induced healing of annular tears.
Criteria For Discogenic Spinal pain Suitable for Percutaneous Disc Lesioning:
Technique:
The patient is positioned in the prone position. A 17-gauge introducer spinal needle is inserted under fluoroscopic guidance into the center of the disc, using a posterolateral approach. A navigable catheter with a temperature controlled thermal resistive coil is then deployed through the needle The catheter temperature is gradually increased according to a uniform protocol to 90°C during a period of 13 min, and maintained at 90°C for an additional 4min. The recommended heating protocol begins at 65°C, and the catheter temperature is increased by 1°C every 30 s until reaching 90°C, which is sustained for a period of 4 min. However, if the patient cannot tolerate the recommended heating protocol, a lower temperature can be used to perform the procedure, based on the belief that the amount of heat delivered over a period of time is more important than the final temperature.
