Abstract
Internal annular disruption (IAD) of the intervertebral disc is a common source of low back pain. Roughly 25% of persistent low back pain comes from IAD. The pathophysiology is most likely irritation of nerves growing in the damaged inner annulus during the attempt to heal the annular tears. The natural history is for pain from IAD to persist. Diagnosis is best done by discography, but that technique has been criticized, so that access to discography is limited.
Multiple therapies have been used to treat IAD. Conservative treatment has not helped. Epidural injections can provide significant relief. Surgical fusion has not shown significant benefit over alternatives. Various intradiscal injection therapies are being investigated but need further study.
Thermal annular procedures (TAPs), in which heat is applied to the annulus, are well studied. Intradiscal electrothermal therapy (IDET) applies conduction heat to the annulus, while both discTRODE and biacuplasty use radiofrequency energy to create ionic heating.
TAPs are an important, minimally invasive, low-risk methodology to treat IAD, a problem which otherwise has a grim prognosis. TAPs should be made available to patients with persistent pain and loss of function from IAD.
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Helm, S. (2018). Percutaneous Lumbar Thermal Annular Procedures. In: Manchikanti, L., Kaye, A., Falco, F., Hirsch, J. (eds) Essentials of Interventional Techniques in Managing Chronic Pain. Springer, Cham. https://doi.org/10.1007/978-3-319-60361-2_16
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