R. Nechifor, B. Dorobat, L. Tomescu, G. IanaSPITALUL UNIVERSITAR DE URGENTA BUCURESTI

Proceduri de Proceduri de radiologie interventionala in radiologie interventionala in Patologia coloanei vertebrale:Patologia coloanei vertebrale:

nucleoplastianucleoplastiapercutanapercutana

Radiologia Interventionala a coloanei

Terapia tasarilor vertebrale Vertebroplastie percutana

Terapia discopatiei lombare sau cervicale Nucleoplastie percutana Ozonoterapie intradiscala si foraminala

Terapia malformatiilor vasculare spinale Embolizare MAV

Terapia metastazelor vertebrale Embolizare intratumorala Radioablatie tumorala Vertebroplastie percutana

Nucleoplastia percutana

Terapia conservatoare a herniei de disc

Nucleoplastia percutana

Algoritm terapeutic

Diagnostic• Examen clinic• Examen imagistic

Tratament conservator• Tratament medicamentos• Fizioterapie• Corset

Chirurgie

Radiculopatia lombara

Interventie chirurgicala

Nucleoplastie percutana

Ozonoterapie / alcool i.d.

Indicatii

Ce este nucleoplastia percutana?

Decompresia discului intervertebral

Punctia discului intervertebral se face sub control radiologic

Decompresia discului intervertebral

Nucleul pulpos extras

Dupa punctia discului intevertebral L4-L5 s-au aspirat aproximativ 1,2 ml. din nucleul pulpos

Decompresia discului intervertebral

1. Durere RADICULARA persistenta cu sau fara durere locala

2. Esecul tratamentului conservator

3. Examenul MRI – hernie continenta < 6 mm

4. Inaltimea discului >50% din inaltimea initiala

Criterii de selectie

1. Stenoza moderata / severa a canalului spinal

2. Fractura vertebrala

3. Formatiune tumorala locala

4. Inaltimea discului <50% din inaltimea initiala

5. Fragment discal migrat in canal

Criterii de excludere

Nucleoplastia percutana

L4-L5 - nucleoplastieL5-S1 - ozonoterapie*

* Daca nu este o urgenta neurochirurgicala

Procedura minim invaziva ce dureaza 30 min.

Fara spitalizare

Fara incizie, fara perioada de recuperare medicala

Rezultate imediate

Pacientul se reintoarece la activitatea normala in 48 ore

Rata extrem de redusa a complicatiilor

Avantajele nucleoplastiei

Nucleoplasty for contained disc protrusion

Patient demographics

n Value

Age (yrs) 106 41.2 ± 13,7

Weight (kg) 106 83,2 ± 22,7

Height (m) 106 1,67 ± 0,3

Sex 106 M=52 F=54

Manual labor (%) 72 68%

Nucleoplasty for contained disc protrusion

Pre-procedure symptoms

Value

Primary Pain Back 74%

Leg 11%

Back&Leg 15%

Percent Time Pain Present 80-100% 71%

50-80% 23%

25-50% 6%

<25% 0

Triggering Event 72%

Duration of Symptoms Prior to Nucleoplasty Mean: 3 years

Nucleoplasty for contained disc protrusion

Prior Treatments

n Value (%)

Physical Therapy 106 88%

Surgery 106 11%

Opioids 106 69%

Non-opioids 106 97%

Nucleoplasty for contained disc protrusion

Results

Pain Relief % 95% CI

> 30% 57% 48%-66%

>50% 44% 35%-53%

•Mean folow-up: 18 months

•No difference in demographics

•No difference in outcome based on primary area of pain

•No periprocedural incidents

Results Visual Analogue Scale

Mean reduction in VAS: 2.3Pain relief did not decrease with time

Results

Medical Group Management Association (MGMA) Patient Satisfaction Questionnaires

R. Nechifor, B. Dorobat, L. Tomescu, G. Iana

SPITALUL UNIVERSITAR DE URGENTA BUCURESTI

Va multumim!