The thermoprobe is a medical tool used to obliterate peripheral nerves. During this procedure, the tip of the probe is heated in a controlled manner. The procedure is usually performed on an outpatient basis under sterile conditions, and the main indication is chronic spinal pain.
What is a thermal probe?
Thermoprobe therapy is a minimally invasive surgical procedure established in pain management, orthopedics and neurosurgery. The procedure itself takes only a few minutes and is performed by experienced physicians even without intraoperative X-ray control. However, a targeted, reliable and, above all, low-complication denervation without X-ray fluoroscopy is not possible. The exact placement of the probe requires millimeter precision, and visual control by means of X-ray fluoroscopy (C-arm) is necessary in several planes. The thermal probe uses heat to obliterate peripheral nerve fibers in the lumbar spine that may be responsible for triggering chronic pain and muscle tension. However, the sclerosed nerve cords can regenerate over time, leading to renewed painful tension, aches or restricted movement. Therefore, it is not uncommon for chronic pain patients to have the procedure performed several times, at intervals of several months. If the pain does not subside as a result of treatment with the thermal probe, then the peripheral nerves in the spine are not the cause of the pain. The medical procedure that is performed with the help of the thermoprobe on the spine is called thermocoagulation. It describes obliteration of nerves by the action of heat. Since protein denatures during this process, it is also referred to as coagulation.
Forms, types, and species
Medical thermal probes are basically of the same design, as they are all aimed at obliterating the finest nerve endings in the spinal column. There are thermal probes, which are suitable for multiple use and thus reusable. For this purpose, the tip of the probe, usually made of steel, is sterilized before each further use. Sterilization as a process to destroy all germs and bacteria must be carried out strictly according to the manufacturer’s specifications. There are also disposable probes that are discarded after a single use on a patient. Practices where a large number of thermal probe treatments are performed daily generally use single-use probes. Multiple probes are significantly more expensive to purchase and are used less frequently today. Which type of probe a practitioner prefers depends on the individual and also on the indication.
Design and mode of operation
Thermal probes for safe and innocuous lesioning of peripheral nerves usually have an overall length of 50 millimeters. Each probe includes a matching generator and a special adapter cable that connects the probe to the generator. A controller allows the physician to precisely set the required heat at the tip of the thermal probe and also to modify it exactly during the procedure. This is because once a nerve has been obliterated, it causes the temperature at the tip of the probe to drop slightly. “At the lumbar spine, probe lengths of 80 millimeters and more are required, and in each case the active heatable probe tip is only 5-10 millimeters in length. The duration of the procedure depends on the number of vertebral segments to be treated. Since two to three segments (4-6 vertebral joints) are usually treated in one session, the procedure can be expected to take at least 30-45 minutes. Sedation by an anesthesiologist is not necessary in most patients and would even be disadvantageous, as there should be constant communication with the awake patient. Local anesthesia is usually quite sufficient. When correctly applied by an experienced specialist, the duration of action is significantly longer in the majority of patients. A year and a half or more is not uncommon.” (Source: Dr. med. Thomas Beckert, orthopaedie-chiemsee.de)
The actual treatment is done by the heated tip briefly and specifically touching a peripheral nerve selected by the physician. The protein of the nerve tip immediately coagulates, this process is called coagulation. The nerve is thus rendered harmless, and pain information can no longer be transmitted through the treated nerve.The tip of a thermoprobe is usually heated to a minimum of 70°C, better 80°-85°C. This temperature is not felt as pain, however, because a local anesthetic is applied before heating. Individual nerve cords can also be sclerosed multiple times in one therapy session.
Medical and health benefits
The medical and health benefits of probe sclerotherapy are considered extraordinarily high in chronic pain patients. Often, treatment with the thermal probe comes at the end of a whole series of conservative pain management measures. Because the thermoprobe treatment is minimally invasive, it is considered to be particularly low-risk and gentle. The treatment is performed in the prone position, usually in the presence of an anesthesiologist who is responsible for sedating the patient during the procedure. General anesthesia is not required and is only justified in exceptional medical cases. The medical benefit is not least due to the fact that by using the thermoprobe, risky stiffening surgery of segments of the spine can be avoided in many cases. The main cause of chronic pain in the spine is wear and tear, such as osteoarthritis, which can then lead to the degeneration of intervertebral discs. Treatment with the thermoprobe therefore does not directly eliminate the cause of pain, for example arthrosis, but interrupts the transmission of pain by obliterating the nerves. In most patients, this leads to a significant reduction in pain after the procedure, if not complete freedom from pain. If the pain-triggering nerve fibers are precisely known through previous diagnostics, the thermoprobe can also be used under imaging. In that case, the additional administration of a contrast agent would be required for a computer tomography as an X-ray control. After the procedure, patients must be monitored, but can then be discharged home immediately. Extensive rest on the day of the procedure is also not necessary, so that normal everyday activities can usually be pursued without restriction. Although treatment with the heat probe for thermocoagulation is very often performed on older people, it is suitable in principle for any age group. Especially patients with chronic complaints benefit from the procedure. In addition to age-related wear of the small vertebral joints, bony changes in the cervical or thoracic spine, for example as a result of accidents or previous operations, can also be successfully treated with the thermoprobe.
