Abstract

Chemonucleolysis and percutaneous discectomy as well as laser decompression and discectomy are used methods besides the rapidely developing endoscopic techniques as minimal aggressive techniques for discal pain syndromes. In recent years, the use of different radiofrequency energy was added to this spectrum. Every technique from thermocoagulation for annuloplasty to the “coblation” must be considered as unique procedure. A new minimally invasive technology for the treatement of discal diseases of the lumbar spine with high radiofrequency based on the extensive use of the percutaneous RF-techniques and and positive experiences with use in endoscopic spine surgery has been developed to recombine the advantages of the different methods in one minimal invasive surgery. The purpose of the presentation is to assess the the feasibility and the potential of this radiowave based combination procedure. First we will discuss basic investigations for the efficacy and safety of this procedure. Then we will present our first clinical results demonstrating the surgical technique with the special assessable probe. Methods: For this first prospective outcome study patients with radicular pain syndromes and simple neurological deficits as well as contained disc extrusions or protrusions has been included. We did the procedures in two different centers by different surgeons in different cultures and investigated the outcome postoperatively and after 6 weeks by a standardized protocol partly by independent investigators. Beside the clinical results two scores has been observed. Results: The VAS is demonstrating an improvement from 8,6 to 1.9 two days postoperative and 3,4 after 6weeks, the 6 month results are in work. The SLRT and the neurological deficits improved significantly. The McNab index is showing on av. an excellent outcome postoperativly and a good after six weeks as well as the Andrews and Lavyene Score. Until now there has been no complications. The first results encourage us to implicate this procedure into the algorythm of disc surgery and seem to be comparable to the other minimal invasive procedures avoiding an open surgery and to fill the gap in the cascade of treatment of discal disorders. The combination of different techniques in one procedure with the use of special radiowave mark an advantage and seems to be superior to a single technique. Cause of the instruments there are further optional opportunities and it is less invasive than an fullendoscopic procedure, but an endoscopic assisted controll is possible.