Percutaneous Decompression Research Articles

Results of a Minimally Invasive Technique for Treatment of Unicameral Bone Cysts

Unicameral bone cysts are benign bone lesions commonly seen in pediatric patients. Several treatment methods have been described with variable results and high recurrence rates. We previously reported short-term success of a minimally invasive technique that includes combining percutaneous decompression and grafting with medical-grade calcium sulfate pellets. The purpose of this study was to review the additional long-term results with a minimum followup of 24 months (average, 37 months; range, 24-70 months). We identified 55 patients with an average age of 10.8 years (range, 1.3-18 years). Forty-one of 55 lesions occurred in the humerus and femur. Forty-four of 55 (80%) patients had a partial or complete response after initial surgery; of these, seven obtained a partial or complete response after a repeat surgery (cumulative healing rate, 94%). Two patients underwent a third surgery (cumulative healing rate, 98%). One underwent a third repeat surgery (cumulative healing rate, 100%). There were no major complications associated with the procedure. Two patients had a superficial infection that resolved with oral antibiotics. Although some patients required a repeat procedure, complete or partial response at a minimum 24 months' followup was achieved in all patients. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Nucleoplasty for disc protrusion: A novel percutaneous decompression technique

Nucleoplasty is an FDA-approved minimally invasive technique for percutaneous decompression of intervertebral disc protrusion. It is indicated for radicular pain, but there are emerging data related to management of discogenic pain. The evolution of minimally invasive spine techniques provides an impetus for pain specialists to ensure the safest and most effective use of these technologies. Due to its relatively recent release, pain management specialists are still exploring its best possible use. In this article, research regarding this technique is summarized and the technique is described. Recent research has been positive in carefully selected populations, and a current, multicenter, randomized, controlled trial should soon clarify its role in treatment of chronic low back pain from the degenerative disc.

Percutaneous cervical disc decompression

Cervical disc nucleoplasty is a significant and clinically demonstrated innovation in percutaneous disc decompression in case of non-herniated disc protrusions or prolpase. It allows a percutaneous decompression via a 19-gauge needle under utilization of the Coblation technique and under C-arm control. Until now the patients suffering of a cervicobrachialgia in cause of a disc prolapse had only the therapeutical solution between conservative treatment and monosegmental spondylodesis or disc prosthesis of the mentioned motion segment. We wanted to demonstrate a new and practicable anatomical pathway for reaching the cervical disc prolapse comparable to the technique for discography of the cervical spine. The introducer needle is advanced into the disc under fluoroscopic guidance using a standard anterior-lateral approach. The controller delivers radiofrequency energy to quickly ablate tissue at temperatures between 50 degrees and 60 degrees C. The decompression will be done in ablation mode by rotating the device through 180 degrees for 5 s in the posterior, medial and ventral third of the cervical disc. After failed conservative treatment over an average time period of 3 months we treated 26 patients with a contained herniated prolapse or protrusion with radicular arm pain by percutaneous decompression under utilization of the Coblation technique with a controlled energy plasma-mediated field. A randomized control group of 30 patients was treated alone conservatively with medical and physical therapy in the same period. The average preoperative VAS was 8.8. With a follow-up time of 2-years we found an average pain reduction with the visual pain score (VAS) of 2.3 who had a further check-up. The VAS was checked 24 h, 1 week, 3, 6, 12 and 24 months postoperatively. No complications with this method were seen. Comparable to the surgically treated group the conservative patients have had a VAS of 8.4. Under using conservative treatment with physical therapy, physiotherapy, analgetics and perineural injections we have had a diminution of the VAS to 5.1 after 2 years. The percutaneous decompression of the cervical disc protrusion with the Perc DC-Spine Wand by using the Coblation mode is a quick and safe procedure. Furthermore, one may state a persistent pain relief in the follow-up time up to 2 years after the percutaneous decompression of the disc.

Percutaneous Curettage and Bone Grafting for Humeral Simple Bone Cysts

Traditional treatments for simple bone cysts are associated with significant surgical morbidity and high recurrence rates. The purpose of this study was to evaluate the effectiveness of a percutaneous approach to the treatment of proximal humeral simple bone cysts that includes percutaneous decompression, curettage, and injection of allogeneic cancellous bone combined with autologous bone marrow. Twenty-one children (average age, 10.1+/-4.6 years) with symptomatic simple bone cysts of the proximal humerus were surgically treated with percutaneous cyst decompression, curettage, and cancellous allograft combined with autologous bone marrow. Patients were observed in-clinic with serial examinations and radiographs. Fracture healing and cyst recurrence were determined at follow-up. All patients returned to activities of daily living with full range of motion and were completely asymptomatic. All fractures healed. There were no surgical complications or refractures. Five patients demonstrated radiographic evidence of partial cyst recurrence and required additional surgical treatment. One patient required a third operative procedure for a second recurrence. Three of 8 active cysts demonstrated partial recurrence. Recurrence was associated with younger age. Our goal in the treatment of proximal humeral simple bone cysts is to prevent cyst recurrence and pathologic refracture. Radiographic evidence of cyst resolution occurred in 75% of our patients using percutaneous curettage and bone grafting, and in 95% of patients with a second procedure. As expected, partial recurrence of active cysts after treatment with this method is high. This percutaneous technique is a safe and effective treatment for humeral simple bone cysts.

Management of Abdominal Compartment Syndrome in a Very Low Birth Weight Neonate Using Penrose Drains and Subsequent Management of Abdominal-Wall Defects

Percutaneous drainage of the peritoneal cavity has been recently evaluated for the treatment of perforated viscous in the very low birth weight (VLBW) neonate and percutaneous decompression for abdominal compartment syndrome (ACS) has been studied in older patient populations. This is the first reported case of using this technique to treat ACS in a VLBW neonate.

Defining Intra-Abdominal Hypertension and Abdominal Compartment Syndrome in Acute Thermal Injury: A Multicenter Survey

The definitions of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are not uniform despite the increasing awareness of IAH/ACS in burn patients. A short survey including definitions, resuscitation protocols, and monitoring practices was sent to every physician listed in the American Burn Association Directory. Thirty-two of 123 (26%) surveys were returned; 22 (69%) were from verified burn centers. Survey respondents said that bladder pressure indicating IAH is 19.6 mm Hg (range 12-30) and ACS is 25.9 mm Hg (range 15-40). Fifteen percentage of those responding do not include clinical sequellae in their definition of ACS. Bladder pressure is not routinely measured by 22 (69%) burn physicians, and staff at 17 centers (53%) wait until the abdomen is tense to measure abdominal pressure. Tense abdomen, along with elevated peak inspiratory pressures (PIP), is used in most centers (94%) to determine IAH/ACS, followed by oliguria (88%), and difficulty ventilating (78%). Resuscitation formulae used are primarily the Parkland/modified Parkland in 24 (75%) burn centers. Criteria for abdominal decompression is based on bladder pressures alone in 25 centers (78%); 16/32 (50%) use PIP, and 10/32 (31%) staff use other criteria including organ dysfunction or increased lactate. Eleven physicians (34%) advocate percutaneous decompression before decompressive laparotomy. Although most United States burn physicians define ACS as >or=25 mm Hg along with physiologic compromise, bladder pressure is routinely measured by only 31% of burn physicians. Most burn staff do not differentiate between IAH and ACS. Consensus definitions of IAH/ACS are necessary for burn care practitioners to compare research studies and discuss outcomes. Concise definitions will promote understanding of the pathophysiological processes involved and allow us to develop data-driven patient care protocols.

Obstruction of the Bypassed Stomach Treated with Percutaneous Drainage: An Alternative Treatment for Selected Cases

Biliopancreatic limb obstruction in Roux-en-Y gastric bypass is an infrequent complication that should be recognized early to avoid the risk of peritonitis and death. In this manuscript, we report a case of acute gastric remnant dilatation secondary to intraabdominal hematoma provoked by trocar injury that was compressing the second portion of duodenum lumen. To treat this problem, we decided on a less invasive treatment consisting of percutaneous decompression of the stomach. The procedure was performed using sonographic guidance with local anesthesia, thus, avoiding a new surgical procedure. In this selected case, percutaneous radiological catheter placement provided an effective decompression of the excluded gastric remnant until spontaneous resolution of the obstruction.

Percutaneous biliary internal decompression in a patient with simultaneous malignant biliary and duodenal obstruction and surgically modified anatomy

Simultaneous involvement and obstruction of the common bile duct and the duodenum presents a difficult and challenging problem to the surgeon, the endoscopist and the interventional radiologist. In the case report we present here, the patient had had duodenal and biliary obstruction secondary to hepatic flexure adenocarcinoma and presented with recurrent obstructive jaundice. As the surgically modified anatomy precluded all conventional endoscopic and percutaneous approaches, it was necessary to use an improvised method of achieving biliary decompression.

Advances in burn care

This article reviews and critiques new developments in the critical care of burn patients. The practice of restrictive transfusion is slowly gaining traction. Abdominal compartment syndrome is associated with resuscitation volumes of 300 ml/kg per 24 h, and percutaneous decompression may be a treatment option. Adrenal insufficiency is common, but whom and when to treat are unclear. Imaging or noninvasive monitoring may confirm renal perfusion before urine output, and the concept of permissive hypovolemia should be explored. There is progress in the laboratory in smoke inhalation and myocardial depression, but no human translation. Antibiotic pharmacokinetics in large burns are unpredictable, and so aminoglycosides (measurable concentrations) are not obsolete. Selective digestive decontamination remains controversial. Nutritional predictions by formula are inaccurate. Oxandrolone is safe and effective in promoting anabolism in large burns. Deep venous thrombosis prophylaxis remains guided only by expert opinion. Females fare worse than male patients after burns. The application of the scientific method to burn care is improving slowly. Randomized controlled trials are becoming more common. There is a need for translation of excellent animal work to the human arena.

Imaging for percutaneous lumbar disc decompression procedures

This article analyzes the proper use of imaging in the performance of procedures for disc decompression by minimally invasive techniques. The importance of obtaining and reviewing images before the procedure is discussed. Reviewed are the positioning, preparation, performance, and follow up of patients undergoing these procedures. The proper views on fluoroscopic imaging are highlighted, and examples are given of desirable images for performing these cutting edge techniques. Clinical pearls and pitfalls for those procedures are reviewed, and examples of proper imaging are shown.

The Fullendoscopic Anterior Cervical Fusion: A New Horizone For The Selective Percutaneous Endoscopic Cervical Decompression

The Fullendoscopic Anterior Cervical Fusion: A New Horizone For The Selective Percutaneous Endoscopic Cervical Decompression

Syndromes canalaires du sportif

Peripheral nerve entrapment syndromes involve the compression of a short segment of a nerve at a specific site, as a result of the vulnerability of that nerve as it passes through a fibroosseous tunnel or an opening in fibrous or muscular tissue. Injury of the nerve may occur as a result of compression by the overlying structures. Another mechanism of injury is traction of the nerve, with or without friction of the nerve, as it travels and sharply changes direction around critical points. Imaging can be particularly helpful for the diagnosis of these uncommon injuries. Percutaneous decompression of a ganglion cyst or perineural injection for therapeutic purposes with the aid of fluoroscopy, CT, or ultrasound guidance can be performed in specific areas.

PR_096: Percutaneous Lumbar Disk Decompression Using the Dekompressor: A Pilot Study

Objective: To report on the outcomes resulting from the use of the Dekompressor, a novel percutaneous decompression technology, to treat patients with lumbar radiculopathy secondary to a herniated disk, who failed comprehensive conservative treatment. Design: Prospective. Setting: Academic spine center. Participants: 47. Interventions: Consecutive patients with lumbar radiculopathy due to a diffuse bulge causing central stenosis, focal protrusion, or disk extrusion. Symptoms, examination, and magnetic resonance imaging had to be corroborative. Each subject failed to improve after a minimum of 4 weeks of physical therapy, oral anti-inflammatories, and epidural space steroid injections. Each subject underwent percutaneous decompression with the Dekompressor immediately followed by a therapeutic selective nerve root block. Main Outcome Measures: Medication usage, Owestry Disability Index (ODI), and visual analog scale (VAS). Results: Average duration of symptoms prior to percutaneous decompression was 37 weeks. 41 of 47 patients remained in the study at 6 months. Of the 6 patients who dropped out prior to 6 months, 4 went to surgery, 1 for acupuncture, and 1 found relief with the use of pregabalin (Lyrica). For 41 patients, the average ODI score dropped from 47.2% to 23% (P<.001), representing a change of 1 full category of disability. A patient underwent percutaneous decompression to treat weakness because there was no pain. For the other 40 patients, the VAS for leg pain was 7.3 preprocedure and 1.7 at 6 months postprocedure (P<.001). 43% had a VAS score of 0, 63% had a VAS score of 1 or less, and 75% had a VAS score of 2 or less. Medication usage dropped from an average score of 3.2 to 2.2 (P<.001). Conclusions: The preliminary data from this pilot study reveal that Dekompressor may be an effective tool to treat lumbar radiculopathy. More definitive conclusions can be made after the 1-year and 2-year data are collected and analyzed.

Poster 84: Tumor Necrosis Factor-Alpha Levels in Herniated Intervertebral Disks

Objective: To determine if tumor necrosis factor-alpha (TNF-α) is present in elevated concentrations within the central aspect of the disk in patients with symptomatic disk herniations. Design: Controlled immunochemical study. Setting: University academic center. Participants: Consecutive subjects undergoing percutaneous disk decompression (PDD) for radicular pain (n=20) and undergoing fusion for axial pain (n=20), serving as controls. Intervention: Nuclear material was removed from the central part of the disk using a fluoroscopically guided percutaneous decompression probe. Tissue was homogenized in a protease inhibitor buffer and assayed for the presence of TNF-α using a colorimetric enzyme linked immunosorbent assay. Control samples were taken from disks of surgical patients undergoing fusion and analyzed in the same manner. Main Outcome Measure: TNF-α concentration. Results: TNF-α was detected in the disk nucleus of patients who presented with a herniated disk and radicular pain in a statistically greater concentration than in disks from patients presenting with axial pain. Mean concentration of TNF-α was 411.2pg/mg tissue in the PDD group, which was significantly higher (Wilcoxon rank-sum test, P<.05) than TNF-α levels detected in the fusion group. Conclusions: TNF-α is a potent inflammatory cytokine that has been implicated in the pathophysiology of disk degeneration as well as radicular pain resulting from herniated disks. Prior studies have demonstrated the presence of TNF-α at the interface between the herniated disk tissue and the nerve root. In addition, the ability of nucleus pulposus cells to synthesize TNF-αin culture has been demonstrated. We report the novel observation that TNF-α is present in significantly higher concentrations in vivo in the nucleus pulposus of patients with herniated discs than in nonherniated control discs and at a site remote from the disk-nerve root interface.

CT-gesteuerte perkutane Nukleotomie mit dem Dissektor zur Therapie chronischer Rückenschmerzen mit radikulärer Ausstrahlung

Percutaneous disc decompression using the Decompressor system is another treatment option for patients suffering from chronic discogenic leg pain. This is the first report on a patient undergoing this procedure under CT-control. A 49 year old man with radicular leg pain showed significant pain reduction after percutaneus decompression of a discal herniation at the L4/5 level. The new system enables qualitative and quantitative measures of the removed disc material. CT-control ensures exact positioning of the device.

Percutaneous Discectomy of Herniated Intervertebral Disc with a Dekompressor®

Background: Radicular pain, associated with herniated intervertebral disc, has been treated with either conservative treatments or a traditional surgical discectomy. Several modalities for minimally invasive percutaneous procedures have been developed as alternatives to a surgical discectomy. Percutaneous decompression using a probe has been recently introduced. Herein, we report the outcome of percutaneous decompression with a for the treatment of a herniated intervertebral disc. Methods: Between August 2004 and April 2005, percutaneous decompression was performed using a , 1.5-mm percutaneous lumbar discectomy probe in 17 patients with a herniated lumbar intervertebral disc resistant to conservative treatments, with the results reviewed retrospectively. The procedure was performed under fluoroscopic guidance after local anesthesia. Disc access was gained with a posterolateral approach on the symptomatic side and intradiscal placement of the discectomy probe in the herniated disc confirmed from the anteroposterior and lateral views on the fluoroscopy. Results: We obtained satisfactory clinical results in 14 patients with a decrease in the initial Visual analogue scale (VAS) of more than 55% and the elimination or reduction of analgesic medication, with a follow-up of 3 to 11 months. Conclusion: We concluded that a percutaneous discectomy with a probe might be an effective alternative for the treatments of painful disc herniations resistant to conservative managements when performed under proper selection criteria.

Percutaneous Cervical Discectomy Using Dekompressor® -A case report-

Cervical radicular pain has been recognized as a common cause of neck, shoulder and arm pain. The initial recommended therapy is based on the medical treatment by anti-inflammatory, analgesic agents, rest, traction and physical therapy. In the case of failure with these therapies, the classical alternative is a surgical discectomy, but this is associated with numerous risks inherent to invasive procedures. As a result, a number of percutaneous intradiscal therapies have developed over the last 3 decades, which have specifically focused on the pathology of the disc. However, these treatments have considerable limitations and success rates, and none allow for the extraction of a quantifiable amount of nucleus pulposus via a 17 gauge introducer using fluoroscopic guidance alone. Herein, we describe our experience using a on a 52 year-old female patient with a cervical disc herniation. Percutaneous decompression in the treatment of cervical disc herniation was successfully performed, with a good outcome.

Percutaneous Decompression of the Bowel with a Small-Caliber Needle: A Method to Facilitate Percutaneous Abdominal Access

In our pediatric interventional practice, we have found that occasionally a loop of bowel is interposed between the stomach and the anterior wall of the abdomen, preventing safe needle access for procedures such as placement of a gastrostomy tube. The use of a small-caliber needle to aspirate air from the colon or small bowel, for bowel decompression, may be a safe way to aid in establishing a safe access route for the subsequent percutaneous introduction of larger needles or tubes. Our retrospective review of patients who have undergone bowel-gas aspiration during an interventional procedure shows that the aspiration of air from the colon with a small-caliber needle is technically easy and may permit completion of an abdominal procedure.

Percutaneous Decompression of Intervertebral Disc Using Dekompressor® -A case report-

Discogenic leg pain has traditionally been treated with conservative treatments or an open discectomy. However, an open discectomy is often associated with complications, and only plays limited roles in the management of painful, nonsurgical, contained disc herniations, where non-operative strategies also commonly fail. As a result, over the last 3 decades, a number of percutaneous intradiscal therapies have evolved, including chemonucleolysis, percutaneous nucleotomy, laser treatments and nucleoplasty, most of which were designed to reduce the intradiscal pressure. However, none of these therapies has allowed for the extraction of a quantifiable amount of nucleus pulposus. The evacuation and decompression of a herniated intervertebral disc by , through an introducer cannula inserted dorsolaterally, represents a new concept in the treatment of radiculopathy associated with disc herniation. We report our experience using a on a 66 years old male patient who had lumbar disc herniation and radicular pain. Percutaneous decompression of the intervertebral disc was successfully performed and the outcome was good.

Ureterocele Causing Anhydramnios Successfully Treated With Percutaneous Decompression

Ureterocele Causing Anhydramnios Successfully Treated With Percutaneous Decompression