New Spine Injection Minimally Invasive Disc Radiofrequency(RF) Decompression Device(L'Disq)

Author: Dr Rajendra Tiruchelvarayan, Gleneagles Medical Centre

OBJECTIVE

Lumbar Spine Pain due to prolapsed intervertebral discs is a common clinical condition encountered. In some patients, conventional medical analgesic and physiotherapy treatment are not effective. Radiofrequency(RF) disc ablation techniques can be used instead. Previous RF Co-blation(RFA) procedures such as RF nucleoplasty have been used. However these only decompress the disc centrally. We present our experience with a newer Minimally Invasive Steerable Disc Decompression Device(L-Disq) for herniated discs(Central and Paramedian). This is able to be navigated to the site of the disc herniation, to achieve a more targeted decompression of the nerve root. This is able to relieve both the back pain and ipsilateral sciatica. We compare this newer technique with our previous central RF decompression nucleoplasty results.

METHODOLOGY

The study was a single Spine Surgeon Prospective Study. Fifty four(54) patients were involved. From November 2015 to September 2017, the author performed only nucleoplasty central decompression RF procedures. From October 2017 to 2022, the author performed L-Disq RF procedures. L-Disq RF procedures were performed in the day surgery operating theatre with fluoroscopic c-arm guidance.

-The Newer L’Disc Steerable RF Device used forL5-S1 L’Disq RFA

RESULTS

There were a total of 54 patients involved. Thirty four(34) patients who underwent the L-Disq procedure were compared to 20 patients who underwent the central disc nucleoplasty procedure. For the L-Disq group, there were 24 male and 10 female patients. Average age was 41.5 years. Overall treatment results were good. Thirty(88%) had improvement of back pain and sciatica. The average Visual Analogue Score(VAS) at 3 months decreased from 7.5 to 1.2(results were statistically significant). Six patients had a 2 level RF procedure done with good results.

There were 4 patients(11.7%) who subsequently needed surgery(Lumbar microdiscectomy). The 4 patients recovered well subsequently. There were no cases of complications such as disciitis, or neural damage.

For the Central Disc RF Nucleoplasty group, there were 20 patients in the study. The overall success rate in improving back pain and sciatica was good. 14 patients(70%) had significant improvement in pain. The average Visual Analogue Score(VAS) at 3 months decreased from 7.5 to 1.5.

At 3 months, 3 patients had recurrence of pain, and 1 patient whose back pain recurred required microdiscectomy surgery. There was 1 case of transient leg numbness, which improved subsequently. There were no complications of infection/haemorrhage.

CONCLUSIONS

We conclude that the L-Disq Radiofrequency procedure has good results for treating small to medium sized lumbar disc herniations(88% success rate at 3 months). The results are better than central radiofrequency decompression procedures. It is an effective minimally invasive treatment modality for herniated lumbar discs.

References:

-Efficacy of a new navigable percutaneous disc decompression device(L’disq) in patients with herniated nucleus pulposus related to radicular pain. Sang Heon Lee, Richard Derby, Dong Geun Sul et al. Pain Medicine 2011;12:370-376

Results of study presented, accepted at Pacific and Asian Minimally Invasive Spine Society Spine(PASMISS) Meeting 2022