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Percutaneous Lumbar Thermal Annular Procedures

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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.

Keywords

  • Internal disc disruption
  • Internal annular disorder
  • Low back pain
  • Radiofrequency
  • Thermal intradiscal therapy
  • Thermal annular therapy
  • IDET
  • discTRODE
  • Biacuplasty

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References

  1. Manchikanti L, Singh V, Pampati V, et al. Evaluation of the relative contributions of various structures in chronic low back pain. Pain Physician. 2001;4:308–16.

    CAS  PubMed  Google Scholar 

  2. Bokov A, Perlmutter O, Aleynik A, et al. The potential impact of various diagnostic strategies in cases of chronic pain syndromes associated with lumbar spine degeneration. J Pain Res. 2013;6:289–96.

    CAS  CrossRef  PubMed  PubMed Central  Google Scholar 

  3. Schwarzer AC, Aprill CN, Derby R, et al. The prevalence and clinical features of internal disc disruption in patients with chronic low back pain. Spine (Phila Pa 1976). 1995;20:1878–83.

    CAS  CrossRef  Google Scholar 

  4. Peng B, Fu X, Pang X, et al. Prospective clinical study on natural history of discogenic low back pain at 4 years of follow-up. Pain Physician. 2012;15:525–32.

    PubMed  Google Scholar 

  5. Derby R, Baker RM, Lee CH, et al. Evidence-informed management of chronic low back pain with intradiscal electrothermal therapy. Spine J. 2008;8:80–95.

    CrossRef  PubMed  Google Scholar 

  6. Peng BG. Pathophysiology, diagnosis, and treatment of discogenic low back pain. World J Orthop. 2013;4:42–52.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  7. Saal JA, Saal JS. Intradiscal electrothermal treatment for chronic discogenic low back pain: a prospective outcome study with minimum 1-year follow-up. Spine (Phila Pa 1976). 2000;25:2622–7.

    CAS  CrossRef  Google Scholar 

  8. Crock HV. A reappraisal of intervertebral disc lesions. Med J Aust. 1970;1:983–9.

    CAS  PubMed  Google Scholar 

  9. Mirza SK, Deyo RA. Systematic review of randomized trials comparing lumbar fusion surgery to nonoperative care for treatment of chronic back pain. Spine (Phila Pa 1976). 2007;32:816–23.

    CrossRef  Google Scholar 

  10. Deyo RA. Fusion surgery for lumbar degenerative disc disease: still more questions than answers. Spine J. 2015;15:272–4.

    CrossRef  PubMed  Google Scholar 

  11. Manchikanti L, Cash KA, McManus CD, et al. A randomized, double-blind, active-controlled trial of fluoroscopic lumbar interlaminar epidural injections in chronic axial or discogenic low back pain: results of 2-year follow-up. Pain Physician. 2013;16:E491–504.

    PubMed  Google Scholar 

  12. De Oliveira Magalhaes FN, Dotta L, Sasse A, et al. Ozone therapy as a treatment for low back pain secondary to herniated disc: a systematic review and meta-analysis of randomized controlled trials. Pain Physician. 2012;15:E115–29.

    Google Scholar 

  13. Peng B, Pang X, Wu Y, et al. A randomized placebo-controlled trial of intradiscal methylene blue injection for the treatment of chronic discogenic low back pain. Pain. 2010;149:124–9.

    CAS  CrossRef  PubMed  Google Scholar 

  14. He F, Pei M. Rejuvenation of nucleus pulposus cells using extracellular matrix deposited by synovium-derived stem cells. Spine (Phila Pa 1976). 2012;37:459–69.

    CrossRef  Google Scholar 

  15. Centers for Medicare & Medicaid Service: National Coverage Determination (NCD) for Thermal Intradiscal Procedures (TIPs) (150.11) 2008.

    Google Scholar 

  16. Bogduk N, Aprill C, Derby R. Lumbar discogenic pain: state-of-the-art review. Pain Med. 2013;14:813–36.

    CrossRef  PubMed  Google Scholar 

  17. Sluijter ME, Cosman ER. Method and apparatus for heating an intervertebral disc for relief of back pain. Google Patents; 1995.

    Google Scholar 

  18. Ball RD. The science of conventional and water-cooled monopolar lumbar radiofrequency rhizotomy: an electrical engineering point of view. Pain Physician. 2014;17:E175–211.

    PubMed  Google Scholar 

  19. Barendse GA, van Den Berg SG, Kessels AH, et al. Randomized controlled trial of percutaneous intradiscal radiofrequency thermocoagulation for chronic discogenic back pain: lack of effect from a 90-second 70 C lesion. Spine Phila Pa 1976. 2001;26:287–92.

    CAS  CrossRef  PubMed  Google Scholar 

  20. Saal J, Saal J. Percutaneous treatment of painful lumbar disc derangement with a navigable intradiscal thermal catheter: A pilot study. Paper presented at: Proceedings of the 13th Annual Meeting of the North American Spine Society, San Francisco, 1998.

    Google Scholar 

  21. Pauza KJ, Howell S, Dreyfuss P, et al. A randomized, placebo-controlled trial of intradiscal electrothermal therapy for the treatment of discogenic low back pain. Spine J. 2004;4:27–35.

    CrossRef  PubMed  Google Scholar 

  22. Freeman BJ, Fraser RD, Cain CM, Hall DJ, Chapple DC. A randomized, double-blind, controlled trial: Intradiscal electrothermal therapy versus placebo for the treatment of chronic discogenic low back pain. Spine (Phila Pa 1976). 2005;30:2369–77.

    CrossRef  Google Scholar 

  23. Davis TT, Delamarter RB, Sra P, et al. The IDET procedure for chronic discogenic low back pain. Spine (Phila Pa 1976). 2004;29:752–6.

    CrossRef  Google Scholar 

  24. Derby R, Eek B, Lee SH, et al. Comparison of intradiscal restorative injections and intradiscal electrothermal treatment (IDET) in the treatment of low back pain. Pain Physician. 2004;7:63–6.

    PubMed  Google Scholar 

  25. Derby R, Lee SH, Seo KS, et al. Efficacy of IDET for relief of leg pain associated with discogenic low back pain. Pain Pract. 2004;4:281–5.

    CrossRef  PubMed  Google Scholar 

  26. Tsou HK, Chao SC, Kao TH, et al. Intradiscal electrothermal therapy in the treatment of chronic low back pain: experience with 93 patients. Surg Neurol Int. 2010;1:37.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  27. Assietti R, Morosi M, Migliaccio G, et al. Treatment of discogenic low back pain with intradiscal electrothermal therapy (IDET): 24 months follow-up in 50 consecutive patients. Acta Neurochir Suppl. 2011;108:103–5.

    CrossRef  PubMed  Google Scholar 

  28. Bryce DA, Nelson J, Glurich I, et al. Intradiscal electrothermal annuloplasty therapy: a case series study leading to new considerations. WMJ. 2005;104:39–46.

    PubMed  Google Scholar 

  29. Cohen SP, Larkin T, Abdi S, et al. Risk factors for failure and complications of intradiscal electrothermal therapy: a pilot study. Spine (Phila Pa 1976). 2003;28:1142–7.

    Google Scholar 

  30. Nunley PD, Jawahar A, Brandao SM, et al. Intradiscal electrothermal therapy (IDET) for low back pain in worker’s compensation patients: can it provide a potential answer? Long-term results. J Spinal Disord Tech. 2008;21:11–8.

    CrossRef  PubMed  Google Scholar 

  31. Saal JA, Saal JS. Intradiscal electrothermal treatment for chronic discogenic low back pain: prospective outcome study with a minimum 2-year follow-up. Spine (Phila Pa 1976). 2002;279:966–73.

    CrossRef  Google Scholar 

  32. Webster BS, Verma S, Pransky GS. Outcomes of workers’ compensation claimants with low back pain undergoing intradiscal electrothermal therapy. Spine (Phila Pa 1976). 2004;29:435–41.

    CrossRef  Google Scholar 

  33. Wetzel FF, Andersson GBJ, Peloza JH, et al. Intradiscal Electrothermal Therapy to treat discogenic low back pain: two-year results of a multicenter prospective cohort study. Spine J. 2002;2:S10–1.

    Google Scholar 

  34. Helm S II, Deer TR, Manchikanti L, et al. Effectiveness of thermal annular procedures in treating discogenic low back pain. Pain Physician. 2012;15:E279–304.

    Google Scholar 

  35. University of the West of England: sample size and power in clinical trials. 2011.; http://www.nbt.nhs.uk/sites/default/files/attachments/Power_and_sample_size_in_clinical_trials.pdf.

  36. Manchikanti L, Pampati V, Damron K. The role of placebo and nocebo effects of perioperative administration of sedatives and opioids in interventional pain management. Pain Physician. 2005;8:349–55.

    PubMed  Google Scholar 

  37. Manchikanti L, Giordano J, Fellows B, et al. Placebo and nocebo in interventional pain management: a friend or a foe – or simply foes? Pain Physician. 2011;14:E157–75.

    PubMed  Google Scholar 

  38. Crombez G, Wiech K. You may (not always) experience what you expect: in search for the limits of the placebo and nocebo effect. Pain. 2011;152:1449–50.

    CrossRef  PubMed  Google Scholar 

  39. Finch PM. The use of radiofrequency heat lesions in the treatment of lumbar discogenic pain. Pain Pract. 2002;2:235–40.

    CAS  CrossRef  PubMed  Google Scholar 

  40. Finch PM, Price LM, Drummond PD. Radiofrequency heating of painful annular disruptions: one-year outcomes. J Spinal Disord. 2005;18:6–13.

    CAS  CrossRef  Google Scholar 

  41. Kapural L, Hayek S, Malak O, et al. Intradiscal thermal annuloplasty versus intradiscal radiofrequency ablation for the treatment of discogenic pain: a prospective matched control trial. Pain Med. 2005;6:425–31.

    CrossRef  PubMed  Google Scholar 

  42. Pauza K. Cadaveric intervertebral disc temperature mapping during disc biacuplasty. Pain Physician. 2008;11:669–76.

    PubMed  Google Scholar 

  43. Petersohn JD, Conquergood LR, Leung M. Acute histologic effects and thermal distribution profile of disc biacuplasty using a novel water-cooled bipolar electrode system in an in vivo porcine model. Pain Med. 2008;9:26–32.

    CrossRef  PubMed  Google Scholar 

  44. Kapural L, Ng A, Dalton J, et al. Intervertebral disc biacuplasty for the treatment of lumbar discogenic pain: results of a six-month follow-up. Pain Med. 2008;9:60–7.

    CrossRef  PubMed  Google Scholar 

  45. Kapural L, Vrooman B, Sarwar S, et al. A randomized, placebo-controlled trial of transdiscal radiofrequency, biacuplasty for treatment of discogenic lower back pain. Pain Med. 2013;14:362–73.

    CrossRef  PubMed  Google Scholar 

  46. Kapural L, Vrooman B, Sarwar S, et al. Radiofrequency intradiscal biacuplasty for treatment of discogenic lower back pain: a 12-month follow-up. Pain Med. 2015;16:425–31.

    CrossRef  PubMed  Google Scholar 

  47. Orr RD, Thomas SA. Intradural migration of broken IDET catheter causing a radiculopathy. J Spinal Disord. 2005;18:185–7.

    CrossRef  Google Scholar 

  48. Cohen SP, Larkin T, Polly DWJ. A giant herniated disc following intradiscal electrothermal therapy. J Spinal Disord Tech. 2002;15:537–41.

    CrossRef  PubMed  Google Scholar 

  49. Eckel TS, Ortiz A. Intradiscal electrothermal therapy in the treatment of discogenic low back pain. Tech Vasc Interv Radiol. 2002;5:217–22.

    CrossRef  PubMed  Google Scholar 

  50. Djurasovic M, Glassman SD, Dimar JR 2nd, et al. Vertebral osteonecrosis associated with the use of intradiscal electrothermal therapy: a case report. Spine (Phila Pa 1976). 2002;27:E325–8.

    CrossRef  Google Scholar 

  51. Ackerman WE 3rd. Cauda equina syndrome after intradiscal electrothermal therapy. Reg Anesth Pain Med. 2002;27:622.

    CrossRef  PubMed  Google Scholar 

  52. Hsia AW, Isaac K, Katz JS. Cauda equina syndrome from intradiscal electrothermal therapy. Neurology. 2000;55:320.

    CAS  CrossRef  PubMed  Google Scholar 

  53. Wetzel FT. Cauda equina syndrome from intradiscal electrothermal therapy. Neurology. 2001;56:1607.

    CAS  CrossRef  PubMed  Google Scholar 

  54. Kapural L, Cata JP. Complications of percutaneous techniques used in the diagnosis and treatment of discogenic lower back pain. Tech Reg Anesth Pain Manage. 2007;11:157–63.

    CrossRef  Google Scholar 

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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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  • DOI: https://doi.org/10.1007/978-3-319-60361-2_16

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