Intradiscal electrothermal therapy treatment for back pain

The intradiscal electrothermal therapy (IDET) procedure is a minimally invasive technique designed to treat discogenic chronic low back pain. The debate surrounding IDET ranges from the concept of the procedure, the technique and patient selection, to its effectiveness. The procedure provides modest improvement; however, it is considered less invasive and destructive than other modalities of treatments available at the present time, and has lower cost. The effectiveness evidence is limited at the present time, but based on the results of six recently published positive single-arm studies, it appears that patients experienced a perceptible clinical benefit from the IDET procedure. Thus, IDET is recommended in patients with moderate functional impairment, relatively well-maintained disc heights and discogenic pain caused by annular tears or protrusions less than 3-4 mm after the failure of less invasive procedures.

Outcome predictors of percutaneous endoscopic lumbar discectomy and thermal annuloplasty for discogenic low back pain

PURPOSE

Endoscopic discectomy with annuloplasty is considered as a novel minimally invasive technique for treating chronic discogenic low back pain (DLBP). The purpose of this study was to evaluate the outcome predictors and to describe technical aspects for endoscopic solutions against DLBP.

MATERIALS AND METHODS

We performed a prospective study of 87 patients who underwent percutaneous endoscopic lumbar discectomy and thermal annuloplasty (PELDTA) for DLBP. The inclusion criteria were disc degenerations with annular tear confirmed by imaging studies and discography. Clinical outcomes were assessed using the visual analog scale (VAS), the Oswestry disability index (ODI), and the modified MacNab criteria. The univariate and multivariate analyses were performed to evaluate the outcome predictors.

RESULTS

The 2-year follow-up rate was 90.8% (79 of 87 patients). The VAS and ODI scores at postoperative 6 months and 2 years were significantly improved (p < 0.001). Based on the modified MacNab criteria, the global outcomes were excellent in 39 out of 79 patients (49.4%), good in 17 patients (21.5%), fair in 10 patients (12.7%), and poor in 13 patients (16.5%). Therefore, the percentage of symptomatic improvement was 83.5% and the success rate (excellent or good) was 70.9%. In the univariate and multivariate analyses, the presence of concurrent disc herniation with DLBP was the most significant predictor (OR = 3.207, 95% CI 1.02-10.06, p = 0.046).

CONCLUSIONS

PELDTA may be effective for patients with chronic DLBP in selected cases. Central disc herniation causing DLBP was the most important predictor for clinical success.

Intradiscal electrothermal therapy for symptomatic internal disc disruption: 24-month results and predictors of clinical success

Object

Degeneration of the intervertebral disc can be the source of severe low-back pain. Intradiscal electrothermal therapy (IDET) is a minimally invasive treatment option for patients with symptomatic internal disc disruption unresponsive to conservative medical care. This study was undertaken in the neurosurgical setting to evaluate 24-month pain and functional outcomes and predictors of clinical success in patients with discogenic back pain treated with IDET.

Methods

Using MR imaging and discography findings, 50 patients with lumbar discogenic pain were identified, underwent IDET treatment, and were followed up for 24 months. Outcomes included assessments of back pain severity based on an 11-point numeric scale and back function based on the Oswestry Disability Index. The Prolo scale was applied to determine economic and functional status at 24 months.

Results

There was an average 68 and 66% improvement in back pain and function, respectively, between pretreatment and 24 months after treatment (p < 0.0001 for both comparisons). A maximum score of 5 on the Prolo scale for economic and functional status was achieved in 63 and 22% of patients, respectively. The global clinical success rate was 78% (39 of 50 patients) based on no reoperations at the affected level due to persistent symptoms, with a ≥ 2-point improvement in pain severity and a ≥ 15-point improvement in back function. Predictors of 24-month clinical success included discographic concordance (p < 0.0001), a high-intensity zone on MR imaging (p = 0.0003), low Pfirrmann grade (p = 0.0002), and more extensive anulus coverage (p < 0.0001). There were no procedure-related adverse events.

Conclusions

The findings of this study suggest that durable clinical improvements can be realized after IDET in highly select surgical candidates with mild disc degeneration, confirmatory imaging evidence of anular disruption, and highly concordant pain provocation on low-pressure discography.