Experimental And Clinical Study Of Radiofrequency Thermo-coagulation In The Treatment Of Lumbar Disc Herniation

SECTION ONEHistopathologic effects of different temperature of radiofrequencythermocoagulation on the pig lumbar disc in vitro.ObjectionTo evaluate the histopathologic and general changes of different radiofrequencytemperature ablation of pig lumbar disc in vitro, and to provide reference for a clinicalradiofrequency thermocoagulation temperature-mode.Material and methodsForty-two normal fresh pig lumbar disc in vitro(contains a disc and two vertebralbodies), Divided into blank control group and experimental group, the experimentalgroup including60℃60S radiofrequency group,70℃60S radiofrequency group、80℃60S radiofrequency group,90℃60S radiofrequency group,95℃60Sradiofrequency group, simulated clinical radiofrequency thermocoagulation group，each group of six specimens, made HE stain, Masson stain and glycogen ABPAS stainafter ablation. Histopathologic changes were evaluated using optical microscope. Results1. Lumbar disc tissue shrinkage increases with the temperature afterradiofrequency, and the more obvious degeneration of tissue color deepened, fuserrange also has an increasing trend. But to a certain temperature did not changesignificantly, the most obvious change is generally simulated clinical radiofrequencygroup.2. HE stain: The collagen fiber of fiber ring arrange orderly and rules, cross thereticular structure, a large number of mucous tissue of nucleus pulposus, no specialarrangement. The collagen fiber arrange disorder after radiofrequency thermo-coagulation, but the nucleus pulposus stain did not see obvious changes.3. Masson stain: The collagen fiber of fiber ring was stained blue, arrange orderly,a few blue of nucleus pulposus; Fiber ring organization become weak gradually, blueproportion reduced, smaller density, and collagen fiber content gradually reduce afterradiofrequency thermocoagulation that the temperature from60℃to90℃inexperimental group, but there no obvious difference between90°,95°and the clinicalsimulation group, no obvious difference between the experimental group the color ofthe nucleus pulposus, are more light than the control group.4. Glycogen ABPAS stain: The collagen arrange orderly of fiber ring at controlgroup, stained by light blue, the nucleus pulposus was stained blue, the color isdeeperand the arrangement no rules; the collagen of fiber ring arrange disorderly afterradiofrequency thermocoagulation,and the blue of nucleus pulposus become weakgradually and thin that the temperature from60℃to90℃. There is only a little blueat90℃,95℃and the clinical simulation group,the acid proteoglycan of nucleuspulposus gradually decrease trend from60℃to90℃, the change is not obvious after90℃.Conclusion1. When radiofrequency temperature higher than60℃, Solidification anddegeneration of intervertebral disc tissue, disorder of collagen fibers, reduce thecollagen fibrosisand decrease the acid proteoglycan. 2. Collagen fiber of Fiber ring decrease with temperature increase and acidglycoprotein content of Nucleus pulposus in a certain radiofrequency temperature(60-90℃), no significant changes of greater than90℃3. Gradually increase the radiofrequency temperature is good for increase theablation range，the change of lumbar disc tissue can not distinguish by radiofrequencythermocoagulation of90℃and95℃. SECTION TWOThe efficacy of radiofrequency thermocoagulation in the treatment oflumbar disc herniationObjectionTo observe the clinical efficacy of radiofrequency thermocoagulation treatmentof lumbar disc herniationMethodsFrom September2012to September2013, chose60cases of lumbar discherniation were treated by radiofrequency thermocoagulation under the C-arm atorthopedic Hospital of Guangzhou Medical College in Liwan,41cases of L4/L5discherniation,19cases of L5/S1disc herniation, all had low back pain and leg pain ornumbness, All cases were newly diagnosed by CT or MR, Patients underwent avariety of conservative treatment methods, but after repeated episodes of treatmentfailure or poor efficacy or improved after treatment. Puncture entered the back-edgedisc from the safety-triangle in a20G needle after1%lidocaine local anesthesia,then made impedance test and electrophysiological test, given60℃,70℃,80℃,90℃and95℃every60seconds,120seconds for ablation to the intervertebral disc. ObservedVAS score and the straight leg-raising changes dure hospitalization, Follow-up sixmonths after discharge, used the modified MacNab method to assessed the curativeeffect.ResultThe VAS score from preoperative (6.8±1.3) points down to (1.2±0.8) pointsat discharge,and the Straight leg raising test increased from preoperatively (38±11)°to (69±10)°; According to the evaluation method for the modified MacNab, theexcellent and good rate by one month after operation61.7%to six months of85%,there were no serious complication.ConclusionsRadiofrequency thermocoagulation for treatment of lumbar disc herniation withsmall trauma, high safety, quick recovery, curative effect and other advantages, that asafe and effective therapy for lumbar disc herniation.