Biopsybell Diskom 2019

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.