Biopsybell Diskom 2019
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Hernia is a common
disorder that occurs
when the intervertebral discs
nucleus pulposus becomes dislodged
from its natural position
inside the annulus fibrosus.
Most annulus fibrosus lesions are
the result of repeated microtraumas
of or a major trauma
that degenerates
to allow the nucleus
pulposus to bulge
and compress the
spinal cord or a nerve,
causing pain in the back
and in the legs.
Position the patient
in hyperextension position
under fluoroscopic guidance
before proceeding with anaesthesia
and device preparation.
Using the Diskom device, spinal
specialists can reduce the pressure
on the nerve root
by removing the nucleus
with a minimal invasive procedure.
The patient has a long history of
severe left lumbar sciatica pain.
About 10 years ago,
he had spinal fusion
for severe L5-S1
spondylolisthesis.
For the past 3 months, his lumbar
sciatica pain has been worsening,
causing severe motion
function impairment.
It was therefore decided to
intervene on the two severe bulges
observed on the MRI at
L2-L3 and L4-L5 levels.
The hernias will be treated
using Diskom device,
consisting of a
trocar-tipped access needle
and a screw-tipped stylet
that makes it possible to remove
material from the nucleus pulposus.
The first step consists
in accessing the disc
using a very simple procedure.
Obtain an anteroposterior
projection, check the monitor
and go to the exact level
of the disc to be treated.
The previous spinal fusion procedure
was performed at L5-S1 level,
whereas we need to
treat the L4-L5 disc above.
Induce local anaesthesia
using lidocaine
and monitor the patient's status.
Later, the anaesthetists
will induce moderate sedation
to avoid any pain when
the needle is inserted.
Make sure that the tip of the
needle is correctly positioned
on a level with
the spinal processes
and take the device to a position
that is 10 cm distant to that point.
Turn the monitor around
to obtain a Scottie dog view:
we need to enter
immediately above the plate
and the screw position
on the right of the patient
in order to access
the inside of the disc.
A landmark is precisely between
the ear and the nose of the dog.
Confirm that the position is correct
by injecting contrast medium
to perform a discogram.
The monitor confirms that we are
inside the disc and that is herniated.
We now proceed with
the decompression of the disc
by inserting the Diskom
device into the cannula.
Once the device has been
enabled using the ON button,
alternate continuous anteroposterior
movements with circular movements.
After about three minutes, switch off
and extract the device, needle
and probe cannula included.
Immediate post operation:
almost immediate mobilization;
immediate post-operative
neurological assessment
and pre-discharge; administration
of pain killers in case of local pain
(Paracetamol is generally sufficient).
Homecare instructions:
rest for 3-4 days,
avoiding movements
that overload the rachis;
pain killers in case of pain
and antibiotic therapy for 5 days
(Amoxicillin/clavulanic acid);
outpatient check-up 5 days from
the operation without complications.
Rehabilitation:
postural rehabilitation
with physiotherapist and osteopath;
proprioceptive gymnastics;
gradual resumption
of normal physical activity.
Outpatient check-ups:
check-up at 5, 15
and 30 day intervals;
assessment of any pain in
the treated innervation region
and any motor sensory deficiencies;
in case of nerve pain,
treatment with vitamin B12,
acetyl levocarnitine, gabapentin
and dexamethasone.