Indication intENTS® Lumbar and Cervical
The goal is to reduce the volume of the nucleus pulposus, thereby achieving a decompression of the nerve roots. Another treatment option is to sclerotize nociceptors in the dorsal annulus curvature. There is also the term High Intensity Zone (HIZ), which is represented in the MRT as a visible sign of disc degeneration (bright zone in the disc ring).
There are two different sets of instruments available that are specially optimized for procedures on the cervical and lumbar spine.
Axial (left) and sagittal MRT of a protrusion in the lumbar spine. Source: Thieme, Der MR-Trainer Wirbelsäule, ISBN 978-3-13-147591-6
Axial (left) and sagittal MRT of a HIZ (High Intensity Zone) in the cervical spine.
Indications for persistent clinical symptoms
- Protrusion of a disc (invertebral disc protusion)
- Disc prolapse without a complete tear of the fibrous ring
- Discogenic pain
Contraindications
- General contraindications
- Free sequesters
- Bony compression (stenosis)
- Complete annular rupture
Benefits for patients
- Very small incision in the skin, virtually no scar tissue
- Procedure can be carried out under local anesthetic
- Can also be performed in an outpatient clinic,minimally-invasive surgery
- Reduced risk of infection
- Long-lasting absence of pain
- Swift return to normal activities
Decompression of the nerve root by reducing the volume of the nucleus pulposus in the event of a disc protrusion, a hidden prolapse or annular fissures.
The purpose of the intervention is to reduce the volume of the disc core, in order to relieve the pressure on the nerve.
To that end, access to the disc is obtained using a small “tube” and then either tissue is removed using forceps or using a bipolar RF probe (e.g. Vaporflex®), the volume of the tissue is reduced via vaporization – both can be combined in the same intervention. The advantage of removing tissue is the opportunity for histological examination. At both start and end, the intervention can be checked using an endoscope.
Treatment of discogenic pain
Dorsal annular fissures can be treated using the bipolar Vaporflex® probe, by applying heat to seal small tears in the disc ring. This effectively relieves the pain and prevents further disc damage.
CT discogram (axial) for L4 with visible annular fissure (arrow).
Source: D. Gillard 2012