what does the procedure percutaneous disc decompression involve the human body what r the risks and the?

Question

side effects and recovery time of this procedure?

Answer 1

It is a procedure that is of benefit to patients with low back pain radiating into the legs from contained herniated discs who have not improved from other treatment options before surgery. It is performed using the instrument that can be seen by going to the first website listed and involves the patient being under sedation and using local anaesthetic with the assistance of an x-ray guidance.

According the the Institute for Clinical Excellence....

1 Provisional recommendations

1.1 Current evidence on the safety and efficacy of percutaneous disc decompression using coblation for lower back pain does not appear adequate to support the use of this procedure without special arrangements for consent and for audit or research.


1.2 Clinicians wishing to undertake percutaneous intradiscal electrothermal therapy for lower back pain should take the following actions.

Inform the clinical governance leads in their Trusts. Ensure that patients understand the uncertainty about the procedure's safety and efficacy and provide them with clear written information. Use of the Institute's Information for the Public is recommended. Audit and review clinical outcomes of all patients having percutaneous disc decompression using coblation for lower back pain.

1.3 Further research will be useful in reducing the current uncertainty and clinicians are encouraged to collect longer term follow-up data. The Institute may review the procedure upon publication of further evidence.


2 The procedure

2.1 Indications

2.1.1 Chronic back pain is a common condition. In most individuals, the pain resolves spontaneously within several months. However, for some people the pain persists, despite specific causes of back pain - such as herniated discs, osteoporosis and fractures - being excluded. Increasingly this pain is being attributed to degeneration of the intervertebral disc, and referred to as discogenic back pain.


2.1.2 Typically, first-line treatment for chronic discogenic back pain is conservative, consisting of pharmacotherapy and/or a multidisciplinary programme which may include exercises, education and behavioural therapy. If the pain does not improve, patients can choose whether to continue with conservative management or to undergo surgery (spinal fusion). Potential candidates for percutaneous disc decompression using coblation are those patients with back and leg pain caused by contained herniated discs.


2.2 Outline of the procedure

2.2.1 Percutaneous disc decompression using coblation is usually performed on an outpatient basis under local anaesthesia and sedation. Under fluoroscopic guidance, a needle is inserted into the affected disc. A probe-like device is then introduced into the disc. The device is heated up to 40-70°C, ablating the centre part of the disc and creating a channel. After stopping at a pre-determined depth, the probe is then withdrawn, coagulating the tissue as it is removed. Around six channels are created during the procedure, the number of channels depending on the desired amount of tissue reduction.


2.3 Efficacy

2.3.1 The evidence was based on a small number of patients from three case series studies. Twelve-month follow-up data were available for only 82 patients. In the largest case series, 75% (52/69) of patients indicated a decrease in their pain scores at 12 months, with 54% (37/69) of patients indicating pain relief of 50% or more at final follow-up. Improvement in sitting (37/69), standing (30/69) and walking (34/69) was also reported by a number of patients at 12 months following the procedure. For more details, refer to the sources of evidence (see Appendix).


2.3.2 The lack of data makes it difficult to draw conclusions regarding the efficacy of the procedure. The lack of long-term and comparative data also makes it difficult to distinguish between the treatment effect and the natural history of the disease, as well as determine whether the benefits of this procedure are sustained beyond 12 months.


2.3.3 The Specialist Advisors expressed uncertainty regarding the efficacy of this procedure.


2.4 Safety

2.4.1 In two of the three studies the authors stated that no complications were observed during or after the procedure. It is difficult to know, however, whether this is because complications are uncommon or whether complications were not systematically detected and reported. For more details, refer to the sources of evidence (see Appendix).


2.4.2 The Specialist Advisors did not report any particular safety concerns, although nerve root damage, infection, haemorrhage or worsening pain were listed as potential complications.

Answer 2

What are your sources? EDIT: The blood-brain barrier is to protect the brain from any number of toxins that our blood may be carrying, not necessarily to protect our brain from the blood itself. I'm not prepared to doubt your statement yet, but I'd still like to see the source to see if that author really intended the statement exactly as you've interpreted it. Can you paste a link? (By the way, the BBB doesn't always work, as it's permeable to alcohol and drugs—that's why we can get drunk and pharmaceutical companies can get rich. But that's another story...) EDIT: Yeah, I've been looking around, and I think you might be confused about blood being toxic to the brain. It's true that technically blood is "separated" from brain tissue because it's in blood vessels, but those vessels permeate the brain itself, as they do in all tissues. But I'm going to go with "Huh?" on this one. She cites a good website. But I'm still open to reading any links you have to offer.

Answer 3

YOU ARE SO REPORTED!