Percutaneous Intradiscal Thermotherapy
PITT Percutanous Tntradiscal Thermotherapy – Subproject 13
Backpain is considered to be the number one complaint of patients in Europe. 90% of all Germans suffer from backpain at least once in their life time. Vertebral disc protrusions or prolases are often the cause of such pain, causing nerve root irritation in the cervial and lumbar spine. For the afflicted patients this often means severe back pain and sometimes even substantial impairment of the patients’ range of motion. One sided overburdening can result in degenerative disc disease even in younger patients. Every year 180,000 people are afflicted in Germany alone; half of whom (up to 80,000) have to be operated on. Spinal interventions in the open high-field MRI present a new option in the treatment of these patients, concerning the minimizing of risk and maximizing therapeutic success. .
The study group Open High-Field MRI is addressing these therapeutic issues with three current research projects. Apart from diagnostics and interventional methods which have been implemented in clinical routine, special treatment methods for spinal diseases are currently being developed.
PITT is an innovative minimal invasive combination of two therapeutic procedures (PLDD and IDET) which were designed to treat chronic back pain caused by lumbar disc protrusions. During PLDD (percutaneous laser disc decompression), the protruded disc is removed by thermal processes which include vaporization and shrinking effects of the laser on the vertebral disc tissue. IDET (intradiscal electrotherapy) on the other hand, is based on the atrophy of pathological pain receptors in the degenerated fibrous annulus encompassing the gelatinous disc nucleus with a radio-frequency (RF) applicator.
After local anesthesia, the afflicted disc is percutaneously punctured in a dorsolateral approach. The exact positioning of the flexible laser applicator is achieved with real-time MR-guided navigation and sensitive structures, such as nerve roots and spinal cord can be protected from accidental lesions. A laser fiber is advanced into the center of the prolapsed disc through the positioned applicator. The heat which is deposited by laser energy induces a small valorization defect which leads to an intradiscal fall of pressure (i.e. Nucleoplasty). In addition to this, the ablation process also causes the disc tissue to shrink: the collagenous fibers in within the disc are caused to shrink in a radial manner and the heat deposition in the fibrous annulus causes the pain receptors to degenerate. Thus, pain receptors are removed and the circular shrinking and vaporization effects reduce the disc pressure, whithout the destabilization of open neurosurgical interventions. Finally, the applicator is repositioned and a flexible probe is introduced through the applicator at the dorsal portion of the nucleus. The probe is ideally positioned such that degenerative tearing in the disc is bridged. With heat being induced, the pain receptors are once again ablated and the dorsal part of the annulus is coagulated and stabilized (i.e. Annuloplasty). All of these interventional steps are monitored with real-time MRI throughout the procedure in the open high-field MRI. With temperature sensitive MR-sequences which were designed especially for lumbar interventions, the temperature effects can be visualized during the procedure and possible adverse heat accumulation in surrounding tissue can be monitored (i.e. MR-Thermometry).
Felix Güttler
Jens Rump
Florian Streitparth
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