Life Fourways Hospital in Johannesburg is pioneering a new minimally invasive surgical procedure that offers a welcome alternative to sufferers of herniated (slipped) discs who would otherwise be facing potential open spinal surgery.

The technique, referred to as a Percutaneous Plasma Disc Decompression (PPDD), requires minimally invasive surgery through a small incision under local anaesthesia. The procedure takes approximately 30-45 minutes theatre time, requires no prosthesis, and the patient is usually discharged the same day and can return to their normal daily activities within a few days.

PPDD is also a fraction of the cost of open spinal fusion surgery. The all-inclusive price of a single or dual-level PPDD procedure is around 80% less than that of a single-level cervical disc replacement or cervical fusion.

The procedure is performed at Life Fourways Hospital by specialist neurosurgeon, Dr Avinash Kolloori, who was first introduced to the technique by Vivid Surgicals last year when he travelled to Seoul, South Korea, to train with the spinal surgeons there.

Vivid Surgicals is the sole distributor on the African continent of the INTO-LB/CB, a disposable medical catheter developed by IntoCare in Korea, where it is now a well-established surgical procedure for herniated discs.

 “Although minimally invasive procedures for this purpose have been around for many years using technology such as laser or radiofrequency, PPDD has been developed to be much safer for the patient and has delivered very promising clinical outcomes for patients thus far,” said Dr Kolloori.

Since 2008, over 50,000 PPDD cases have been performed in South Korea and it is now the primary surgical technique utilised when attempting to treat cervical and lumbar disc disease.

During the procedure, a specialised catheter is inserted into the disc through a needle. Heat is introduced through the plasma tip, which ablates the tissue in the disc. This aids in reducing pressure within the disc and allows for the retraction of the herniated disc fragment away from the nearby compromised nerve root, thus reducing and even eliminating the pain symptom.

The entire procedure is performed in theatre and under X-ray guidance to ensure sterility, optimal catheter tip placement, and to reduce the overall risk to the patient.

According to Dr Kolloori, the tip of the catheter is not only safer because it uses far lower temperatures than previous technologies, but due to its curved shape and ease of manipulation, it enhances accuracy when localising the lesion.

Dr Kolloori noted that among his patient population, there are many patients who do not fulfil the absolute criteria for open surgery, but who also do not respond to conservative treatment such as pharmacotherapy or physiotherapy. These patients are left to endure chronic pain with no guarantee of recovery using conventional modalities.

He hopes that the PPDD procedure could potentially give these patients some improvement in their quality of life by reducing their pain and improving their functional capacity.

Dr Kolloori added that not every patient will meet the criteria for the PPDD procedure, and there are inclusion/exclusion criteria based on MRI findings and clinical symptomology.

“But, what it does offer is one more therapeutic modality to the neurosurgeon’s arsenal, which I am convinced will help many patients avoid open surgery, or at least postpone it until they are much older,” said Dr Kolloori.

From the cases performed at Life Fourways Hospital to date, according to Dr Kolloori the results have been very promising, with some patients showing almost complete recovery in the first few weeks post procedure.

Despite the small number of PPDD procedures performed to date in South Africa, some medical schemes have already agreed to pay for the procedure and Dr Kolloori is confident that as patient outcomes speak for themselves, more will follow.

According to MD of Vivid Surgicals, Ian Robertson, after years of continuous development of the IntoCare PPDD product, it finally received CE marking late in 2016 and has started rolling out across the EMEA region.

“The visionary approach to pain management at Life Fourways hospital places it at the forefront of the drive to assist the many people suffering from back and neck pain, and I’m confident that the availability of PPDD will enable it to bring further relief to thousands of sufferers in the coming years,” concluded Robertson.

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