Intradiscal Electrothermal Annuloplasty

Invasive Treatments for Low Back Disorders

OBJECTIVE

This abbreviated version of the American College of Occupational and Environmental Medicine's Low Back Disorders guideline reviews the evidence and recommendations developed for invasive treatments used to manage low back disorders.

METHODS

Comprehensive systematic literature reviews were accomplished with article abstraction, critiquing, grading, evidence table compilation, and guideline finalization by a multidisciplinary expert panel and extensive peer-review to develop evidence-based guidance. Consensus recommendations were formulated when evidence was lacking and often relied on analogy to other disorders for which evidence exists. A total of 47 high-quality and 321 moderate-quality trials were identified for invasive management of low back disorders.

RESULTS

Guidance has been developed for the invasive management of acute, subacute, and chronic low back disorders and rehabilitation. This includes 49 specific recommendations.

CONCLUSION

Quality evidence should guide invasive treatment for all phases of managing low back disorders.

The Percutaneous Endoscopic Lumbar Interbody Fusion (PELIF): An Advanced and Innovation Technique

The degenerative spine changes, and its costs, have increased with high rates of work absenteeism and difficult clinical management. The search for minimally invasive treatments, with better results and early patients recover, with rapid hospital discharge are alternatives for these problems. The percutaneous endoscopic lumbar interbody fusion (PELIF) is a new and advanced option.

Nonsurgical interventional therapies for low back pain: a review of the evidence for an American Pain Society clinical practice guideline

STUDY DESIGN

Systematic review.

OBJECTIVE

To systematically assess benefits and harms of nonsurgical interventional therapies for low back and radicular pain.

SUMMARY OF BACKGROUND DATA

Although use of certain interventional therapies is common or increasing, there is also uncertainty or controversy about their efficacy.

METHODS

Electronic database searches on Ovid MEDLINE and the Cochrane databases were conducted through July 2008 to identify randomized controlled trials and systematic reviews of local injections, botulinum toxin injection, prolotherapy, epidural steroid injection, facet joint injection, therapeutic medial branch block, sacroiliac joint injection, intradiscal steroid injection, chemonucleolysis, radiofrequency denervation, intradiscal electrothermal therapy, percutaneous intradiscal radiofrequency thermocoagulation, Coblation nucleoplasty, and spinal cord stimulation. All relevant studies were methodologically assessed by 2 independent reviewers using criteria developed by the Cochrane Back Review Group (for trials) and by Oxman (for systematic reviews). A qualitative synthesis of results was performed using methods adapted from the US Preventive Services Task Force.

RESULTS

For sciatica or prolapsed lumbar disc with radiculopathy, we found good evidence that chemonucleolysis is moderately superior to placebo injection but inferior to surgery, and fair evidence that epidural steroid injection is moderately effective for short-term (but not long-term) symptom relief. We found fair evidence that spinal cord stimulation is moderately effective for failed back surgery syndrome with persistent radiculopathy, though device-related complications are common. We found good or fair evidence that prolotherapy, facet joint injection, intradiscal steroid injection, and percutaneous intradiscal radiofrequency thermocoagulation are not effective. Insufficient evidence exists to reliably evaluate other interventional therapies.

CONCLUSION

Few nonsurgical interventional therapies for low back pain have been shown to be effective in randomized, placebo-controlled trials.

Industrial medicine and acute musculoskeletal rehabilitation. 5. Interventional procedures for work-related lumbar spine conditions

This chapter emphasizes the importance of establishing a differential diagnosis for low back pain (LBP) with and without referred lower-limb pain and outlines potential interventional treatments appropriate for each diagnosis. It is part of the study guide on industrial rehabilitation and acute musculoskeletal rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. The article specifically focuses on the various interventions used to diagnose or treat those conditions commonly seen in patients with work-related LBP or referred pain in the lower limb. Current criterion treatments for lumbar disk pain, including surgical options, are reviewed.

OVERALL ARTICLE OBJECTIVE

To give an overview of the current state of diagnosis and treatment options for low back pain with or without referred leg pain focusing on interventional procedures.