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Transarticular laser discal fragmentectomy. A new minimally invasive surgical approach for challenging disc herniations in the elderly – Back Pain Doctor Harley Street

Transarticular laser discal fragmentectomy. A new minimally invasive surgical approach for challenging disc herniations in the elderly

Case Reports

. 2014 Oct 31;20(5):555-63.


doi: 10.15274/INR-2014-10085.


Epub 2014 Oct 17.

Affiliations

Free PMC article

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Case Reports

Giuseppe Bonaldi et al.


Interv Neuroradiol.


.

Free PMC article

Abstract

This report describes two elderly patients with large disc fragments extruded into lumbar radicular recesses not treatable by any conventional conservative, minimally invasive or surgical approach. Direct access to the disc fragments was obtained crossing the articular zygapophyseal cavity instead of the interlaminar space and spinal canal, using a small needle through which a laser fibre was inserted to deliver energy for tissue ablation. The procedures obtained regression of both symptoms and the bulk of the fragments at early and late clinical and MR follow-ups.


Keywords:

disc herniation; laser; percutaneous disc decompression.

Figures


Figure 1

Figure 1

Sagittal (A) and axial (B) MR images depicting a large extruded fragment originating from the L4-L5 disc space, compressing the dural sac and occupying the entire right L5 radicular recess.


Figure 2

Figure 2

Transarticular laser fragmentectomy. The 22 G needle traversing the synovial cavity directly enters the discal fragment. The optic fibre (not visible) is passed through it. Arrows show gas from tissue vaporization. The gas diffuses through the nucleus material, entering the disc space.


Figure 3

Figure 3

MR follow-up at 2 months shows complete regression of the herniation.


Figure 4

Figure 4

MR (A) and CT (B) axial images showing a large sequestered disc fragment occupying the left radicular recess and markedly compressing the dural sac.


Figure 5

Figure 5

L3-L4 intradiscal decompression by means of an aspiration probe.


Figure 6

Figure 6

Transarticular laser fragmentectomy. Note repositioning of needle and fibre during the procedure in both cranial-caudal and lateral-medial directions. Note also the different distribution of gas from tissue vaporization in the two situations, and its progressive diffusion and accumulation in the centre of the disc (where it was not present pre-operatively).


Figure 7

Figure 7

MR follow-up at 2 months shows marked regression of the herniation with re-expansion of the dural sac.


Figure 8

Figure 8

Trans-canalar PLDD in a young patient. A) Disc herniation occupying the radicular recess (arrow). B) Trans-canalar access to the disc space for laser intradiscal decompression. C) Bubbles from nucleus vaporization in both disc space and radicular recess. The arrow shows reopening of the radicular recess thanks to immediate reduction of disc volume due to nucleus shrinkage.

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