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. 2022 Aug 13;8(1):63.
doi: 10.1186/s40981-022-00554-z.

Successful annuloplasty using the cone-beam computed tomography-assisted radiofrequency thermocoagulation system in a patient with severe vertebral deformity: a case report

Shintaro Hagihara  1   2 , Masayuki Nakagawa  3 , Kana Matsubara  3 , Kohei Godai  4 , Kenya Kamijima  3 , Yoichiro Abe  3
Affiliations

Successful annuloplasty using the cone-beam computed tomography-assisted radiofrequency thermocoagulation system in a patient with severe vertebral deformity: a case report

Shintaro Hagihara et al. JA Clin Rep. .

Abstract

Background: Complex anatomical features are challenging for minimally invasive intradiscal therapy owing to insufficient visualization for accurate needle advancement. We report the case of a patient with dysraphic vertebral pathologies who presented with L5/S1 degeneration and was successfully treated with annuloplasty using the cone-beam computed tomography (CBCT)-assisted radiofrequency thermocoagulation system.

Case presentation: A 34-year-old woman presented with a lower back and left radicular pain of L5/S1 discogenic origin, accompanied by spina bifida occulta and lumbosacral transitional vertebra. Radiofrequency annuloplasty was performed to preserve disc height and spinal stability, with real-time CBCT guidance for the congenital and degenerative conditions. The procedure relieved her left lower-extremity pain and magnetic resonance imaging revealed that the L5/S1 disc bulging decreased while the disc height was preserved.

Conclusion: Optimal accessibility of radiofrequency thermocoagulation and effective needle guidance using CBCT significantly improve the success rate of annuloplasty at the L5/S1 degenerative disc with severe vertebral deformity.

Keywords: Annuloplasty; Cone-beam computed tomography; Degenerative disc disease; Lumbosacral transitional vertebra; Radiofrequency thermocoagulation; Spina bifida occulta.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The radiofrequency thermocoagulation system. A 16-gauge spine needle is used as a cannula through which a 1-mm-diameter radiofrequency thermocoagulation probe is placed
Fig. 2
Fig. 2
Preoperative image evaluation. a Sagittal, axial, and reconstructed 3-dimensional computed tomography images show the left L5/S1 abnormal facet complex and unco-ossified S1 lamina (red arrows). b Sagittal and axial T2-weighted magnetic resonance imaging show the L5/S1 degenerative disc compressing the existing left S1 nerve. c Axial computed tomography discography shows the morphologically violated disc at L5/S1. The contrast medium enters the posterior annulus
Fig. 3
Fig. 3
Multiplanar reconstructions for needle guidance. The real-time needle trajectory is confirmed in the axial, sagittal, and coronal oblique planes
Fig. 4
Fig. 4
Live fluoroscopy for needle deployment. The tip of the needle is confirmed at the anteroposterior and lateral projections
See this image and copyright information in PMC

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