Background & Aims

Lumbar spinal degenerative diseases had been determined as a common spinal disorder in elderly persons. Recently, trans-sacral epiduroscopic laser decompression (SELD) for HLD has been introduced as a promising alternative to PEN. SELD was the interventional choice of HLD and SS by Holmium:YAG laser. But laser treatment had been some problem like high temperatures around laser tip, lager size of laser machine, and expensive prices. This animal study is about the trans-sacral epiduroscopic plasma decompression (SEPD) by ablation of plasma catheter instead of laser fiber. This study is the first research about SEPD by plama catheter in animal. The purpose of this study is to confirm the safety of SEPD.

Methods

We used two female pigs. After the pig was placed in the prone position under general anesthesia, an 1cm incision was made on the sacral area of pig. As the pig does not have a sacral hiatus, a Smartscopy of Epidural Endoscopic System (RF medical, Seoul, Korea) was inserted into the caudal epidural space through the interlaminar space of the sacrum. A Smartscopy was advanced to the targeted lumbar region under fluoroscopic guidance. Through the working channel, CureDisc (RF medical, Seoul, Korea), plasma ablation electrode catheter, was inserted. Plasma ablation was performed in lumbar disc segment from central area to subarticular area. After autopsy of pigs, histological analysis was also performed to evaluate the amount of tissue ablation and damage to nerve tissues.

Results

Through the epiduroscope, epidural structures like dura mater, nerve roots, epidural fat, epidural space were visualized. For visualization of ventral side of epidural space, pigs were prone position over the several bed sheets. It was easy to see the ventral side of epidural space.
After the experiments, pigs were observed and test with allodynia for nerve injuries, but pigs neither showed abnormal motor behavier nor any signs of pain, allodynia, and paresis.
On autopsy, spinal cord and spinal nerve root were dissected and observed histologically in microscope. But there were no thermal damages in nervous tissues.

Conclusions

SEPD had not showed severe complications in pigs. SEPD would be a good method of spinal decompression.

References

Tamagawa S, Nojiri H, Okuda T, Miyagawa K, Sato T, Takahashi R, Shimura A, Ishijima M. Trans-Sacral Epiduroscopic Ho:YAG Laser Ablation of the Ligamentum Flavum in a Live Pig. Spine Surg Relat Res. 2021 Oct 11;6(2):167-174. doi: 10.22603/ssrr.2021-0126. PMID: 35478976; PMCID: PMC8995116.

Presenting Author

Jong Bum Choi

Poster Authors

JONG BUM CHOI

PhD

Ajou University Hospital

Lead Author

Jee Hwan Moon

M.D.

Ajou University Hospital

Lead Author

Na Eun Kim

M.D.

Inha University Hospital

Lead Author

Topics

  • Treatment/Management: Interventional Therapies – Minor surgical procedures