Physician - Frequently Asked Questions
Physician FAQ's:
Q: What is Plasma Disc Decompression?
A: Plasma Disc Decompression is a term used to describe a disc decompression performed using Coblation® technology to remove tissue in the nucleus pulposus of the disc. Plasma Disc Decompression utilizes a minimally invasive surgical approach to remove disc material and decompress the disc. This is accomplished via a multifunctional device that utilizes Coblation technology to ablate, or remove tissue. Because tissue removal is achieved at low temperatures of approximately 40-70ºC, thermal damage to surrounding tissue is minimized. Coblation technology has been used in over 4.5 million procedures worldwide.
Q: Are the products and technology used in this procedure FDA cleared?
 A: Yes. The SpineWand® surgical devices, including the DLR, DLG, and DC have FDA 510(k) clearance for "ablation, coagulation, and decompression of disc material to treat symptomatic patients with contained herniated discs." The products are also CE marked.

Q: What are the key elements of the procedure?
A: Plasma Disc Decompression is performed on an outpatient basis, with minimal anesthesia requirements. Fluoroscopic guidance is employed as an introducer cannula is placed at the nucleus/annulus junction. A SpineWand is introduced through the passage way, and advanced into the nucleus using Coblation. In lumbar procedures channeling is stopped at the anterior annular wall. The same procedure is repeated six times within the disc. After the device and introducer are removed, a surgical dressing is placed on the incision site and the patient is discharged home. Patients are then usually placed on a routine rehabilitation program.

Q: Do you need to aspirate the by-products from ablation?
A: No. The low molecular weight gases produced by ablation pass out of the disc via the introducer cannula. Cadaver and animal studies, along with extensive clinical experience, confirm that aspiration is unnecessary.

Q: Can you perform the procedure immediately after a discogram?
A: Yes. Use the 17 gauge Crawford cannula for access (when performing the discogram), and the cannula can remain in place in the annulus for the Plasma Disc Decompression procedure. For improved imaging of the DLR Wand, physicians have suggested a 50% dilution of the contrast used during the discogram.

Q: Can more than six channels be created?
A: Some practitioners have used more than six channels, or used a bilateral approach creating up to twelve channels in total.1 

Q: Should a physician inject antibiotics into a disc treated with Plasma Disc Decompression?
A: Many physicians will administer antibiotics anytime the annulus is penetrated – due to the increased risk of infection. They generally use the same dose as following a discogram through the Crawford cannula into the nucleus. Some physicians may elect to administer the antibiotics through the patient's IV.

Q: Does a Plasma Disc Decompression patient need to wear a brace after the procedure?
A: A brace is not required, since the annulus has not been compromised by the procedure. However, a number of Plasma Disc Decompression centers are using a soft brace for two reasons:
  • The brace reminds the patient that they have had a minimally invasive surgical procedure, and they should allow their back to heal (as they progressively return to normal activities).
  • The brace requires the patient to maintain good posture for their lower spine – as part of an overall program of post-procedure rehabilitation (to teach the patient good habits for spine posture and conditioning). A Rehabilitation protocol is intended to support an optimal outcome from the Plasma Disc Decompression procedure, while helping the patient to avoid re-injury.
Q: Is a Rehabilitation Protocol recommended following the procedure?
A: A rehabilitation protocol is recommended, but not required for Plasma Disc Decompression. Most centers have utilized the same rehabilitation guidelines as they utilize for other interventional spine procedures: bed rest for several days, progressive use of stretching and strengthening exercises, followed by staged return to more normal activities. These physicians have observed that rehabilitation enhances and sustains the relief provided by the Plasma Disc Decompression procedure.

Q: What research is currently underway?
A: Extensive studies have been completed to document the affects of the procedure. Basic science research includes studies of the biochemistry, histology (acute and chronic), temperature, and pressure relative to Plasma Disc Decompression. Clinically, multiple centers around the United States, both in University and private practice settings are conducting clinical trials. There are independent studies taking place in Europe, South America, and the Far East as well. A number of these studies, both basic science and clinical, have been accepted for presentation at national meetings. A multi-center randomized study is now underway comparing Plasma Disc Decompression to conservative care.

Q: Where can I review clinical results?
A: Contact your ArthroCare Sales Representitive for the latest clinical information.

Q: When and where will training sessions or workshops be held?
A: ArthroCare Spine will sponsor local and national training presentations, courses at major meetings, and provide proctorships for interested clinicians. Visit our Events section of our website for a complete listing. Contact your local ArthroCare Representative to request an opportunity for training.

Q: What are the patient indications for Plasma Disc Decompression?
A: Click here to view optimal patient selection.

1 Quality of Life Assessment in Patients Undergoing Nucleoplasty-Based Percutaneous Discectomy, Journal of Nurosurgery: Spine January 2006, Volume 4, Number 1, Peter C. Gerszten, MD
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