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SAN DIEGO SPORTS MED PAGE 02 ^ 

J8/17/1998 09:01 6195821497 ^ Dit 

NASS-APS First Joint Meeting. Charleston SC, April 1998 

Thermal Characteristics and ihe Lumbar Disc. Evaluation of a Novel Approach to Targeted 

Intradbcal Thermal Therapy 

Jtfrey A. Sual, MD; /oef S. Saal, MD; /o>m AAky, MS Menlo Park. CA 
introduction: CoUagen fibres shrir*^ 

Thermal shrinkage of collagen to P^^P^^^i^SsrSge and stiffening of 
shoulder dislocations. Thermal properties Of eoBagen ^f^uc^d/oTd^cal sensitization 
the annular wall. Diacogerdcpain may be *SF**y. T^^^aung^rlular nociceptors 
of annular nociceptors Altering ^^J^Xtebd ^liScTSS^ Scornplished by a centrally 

^^ll^ 

fcsSry^rSSre J^oSS^M heat thermal across the 
posterior annular wall in a specified therapeutic range. 

and Methods: Fart t Human Cadaveric Bench ' Nggta ^^J^^ 
"prepared Kuman cadaveric lumbar spines were ^^^^XHxtrapedicular 
cadaver spines totaling 20 usable discs were p^etrated dissection id direct 

discographic approach, and the disUnce *r " P^^^^^terior zone. The failure of 
visuaUzation. llontof the needle P^^^f^f^S^f^ular wall, prompted die 
the needles to navigate .posteriorly SSy able to navigate through the 

development of ^^^^^'.SiSfT^SZ annLl/nudear interface. Part tt 
intra-nudear cavity and be placed a djacent io me K-^^ at 485 kHz was used 
Human Cadaveric Bench Thermal Application. ^^"f^Jl.^Z^^ cav ity (as per 
intradiscally after successful placement of the needles ;m k ,m ^n«™ — .„ me 

rapid rise 

Parti). Consistently (20/20) the JSg^r^ The TRC was able 

of impedance. This led to the development of a thermal resisnve cou vi J*W ^ Animal 
toX the Intradiscal temperature 10*- was 
Thermal Mapping Model A Uve pig was prepared. g^Eff^ ^3y«d. A thermal 
obtained an5 a postero ^^''^.^^J^J^S advent to the posterior 
probe was placed intradiscally and ^fnnocouples ^fP^ The temperature 

annular waif the inferior and superior end plates and ^ ^udearc^ ry 
was raised by 10° C across the posterior ^^^J^^^^Z^^c resonance imaging 
Navigation Study. A previously prepared h , un ^jX ^ TMs d^^as entered under C/T 
ofthflumbarspmetolocateana^^ a standard 

guidance with a specially designed senu-ngri ""J^^JJJ; £ffi 0 navigate the 
eVtrapedicular discographic approach. ^^J^S^SSanoi NucYear Shrinkage A 

» evd^^^ 

volume) and 20% of focal nuclear shrinkage (by volume) was noted. 

Conclusions: It is not feasfcle to place a 

nudeaTmterf ace corresponding to &ve >four tn catheler placement adjacent 

semi-rigid catheter intradiscally within the nudear ~ fc-aWc ^W^fcr hc-i 

U, th« pwteriet «nttl»r wJl, ,t Ac fou, to o dock ^1 _ ~1 

achiov-d with a navigable catheter system. ^J^'^" ^ ly "S agno scd chronic discogcruc 
targeted thermal therapy is effective >n the treatment of precisely m gn 

lumbar pain.