PPDD Percutaneous Plasma Disc Decompression Jong Bum Choi

PPDD (Percutaneous Plasma Disc Decompression) Jong Bum Choi, M. D. Ajou University Medical Center Department of Anesthesiology and Pain Medicine Pain Clinic

PPDD (Percutaneous Plasma Disc Decompression) v v Method of disc decompression Based on experiences with previous products such as Chymopapain, Nucleotome Provides a safe and controlled therapy Disc decompression treatment by ablating nucleus pulposus with Low Temperature

PPDD vs Coagulation PPDD(=Ablation) 01) Definition Medical procedure in which part of the electrical conduction system of the heart, tumor or other dysfunctional tissue is ablated using the heat generated from high frequency alternating current 02) Goal Removing tissue in a defined area. Coagulation 01) Definition The volumetric or length reduction of tissue using thermal energy in a surgical procedure 02) Goal Tissue shrinkage Hemostasis

application field of Ablation v Tumor Treat tumors in the lung, liver, kidney, and bone, as well as other body organs v Cardiac arrhythmia Atrial fibrillation (AF), supraventricular tachycardia (SVT), atrial tachycardia, Multifocal Atrial Tachycardia (MAT) and some types of ventricular arrhythmia v Wound debridement v D) Arthroscopy, Spine, ENT

Advantages of RF ablation Intocare PPDD v Working at lower temperatures (40~70°C). Vs. Electrocautery generates 400~600°C tissue temperatures v Precise targeting Allow the surgeon to ablate the tissue in a specific area with minimal effect to the surrounding tissue. Plasma is only 100 -200 μm thick around the active electrode. v Preserves tissue quality Since the tissue is dissolved of volatilized at the molecular level, and not burned or otherwise mechanically abraded.

What is Plasma? is plasma What is plasma 01) Electrode for generating plasma 65℃~80℃ 01. Ablation Below 65℃ Electric Field 02. Coagulation 1 st electrode Insulator 2 nd electrode

What is Plasma? is plasma? What is plasma? 02) How does the Plasma made? 1 Electric Field 2 1 st electrode Insulator 2 nd electrode 4 3 vapor layer

Intocare PPDD What is Plasma? 03) Plasma field A) The plasma field is an ionized gas consisting of free electrons, ions and excited radicals. B) In contact with biological tissue, these plasma particles are sufficiently (re)active to disintegrate organic molecular within the tissue into elementary molecules Figure 1. The yellow glow emitted by a INTO LB device functioning in a saline environment shows the plasma field. C) In this manner, the target tissue is effectively dissolved or volatilized in a gentle fashion (at low temperature) inducing no damage to surrounding healthy tissue.

Intocare PPDD Proven Treatment Confirmed Safety of Plasma Molecular dissociation by Plasma Energy No damage on the surrounding tissue Decompression of herniated disc with discectomy Histological confirmation No damage No necrosis to Surrounding Tissue

Intocare PPDD Ablation through Into Series Into LB is used for discectomy and modulation on the lumbar disc Leading to the disc decompression and removal of nociceptor

Intocare PPDD -> Easy Access to the target lesion with no risk of disc reherniation OD of the needle : 1. 83 mm OD of direction controllable catheter : 1. 2 mm

Patients Selection of Cervical PPDD v v Radicular Pain (Lateral herniation) - Arm pain - MRI evidence of contained disc protrusion - Not surgical indicated (motor weakness, etc. ) - Failed Nerve Block. Axial Neck Pain (Central focal herniation) - Failed conservative therapy for 3 months - Discography positive for concordant pain - Disc height > about 75%

$Exclusion Criteria v v Red flag - Spinal fracture, tumor, infection - Central cord$

Exclusion Criteria v v Red flag - Spinal fracture, tumor, infection - Central cord lesion Benign Lesion - 50% loss of disc height - Extruded or Sequestered disc - Moderate to Severe spinal stenosis - Complete annular disruption - Degenerative instability - Herniation greater than 1/3 the diameter of the spinal canal

PPDD in Lumbar spine v Same as Cervical Spine basically v More Ablation is needed due to large disc. v Curved catheter is required. It is Technically Complicated. v Clinical outcome in Cervical spine is immediate, comparing with lumbar spine.

PPDD in cervical spine v Anterior approach v Contralateral (or Ipsilateral) approach v Between Trachea and Major vessel

PPDD case study_HCD [ Pre MRI ] [ Post MRI ]

PPDD Case study_Epidurogram(Pre/Postop) [ Pre Epidurogram ] [ Post Epidurogram ]

[ Pre Epidurogram ] [ PPDD ] [ Post Epidurogram ]

[ Pre Epidurogram ] [ Post Epidurogram ] [L 5] [ PPDD ] [L 5]

PPDD case study_HDD [ Pre MRI ]

PPDD case study_black disc with annular tear [ Pre MRI ]

Position of Cervical PPDD case

PPDD in Cervical Disc

PPDD in Lumbar Disc v Posterior approach v Contralateral or Ipsilateral approach

Electrode type v v Straight type (Into-S): one way ablation Curved type, Steering type (Into-LB/CB): multi directional ablation [ Into-S ] For cervical spine [ Into-LB ] [ Into-CB ] For cervical / lumbar spine

Moto of PPDD v Safe v Effective v Simple v Easy

Thank you for attention