Efficacy of Coblation Technology in Treating Cervical Discogenic Upper Back Pain

Abstract

Upper back pain originating from the cervical disk itself is defined as cervical discogenic upper back pain. Coblation procedures can provide therapeutic effects for neck and radicular pain related to contained cervical disk herniation. However, no studies have reported the performance of coblation procedures, particularly for treating cervical discogenic upper back pain. The purpose of this study was to evaluate the efficacy of coblation procedures in treating cervical discogenic upper back pain.In a prospective, clinical, observational study, 28 consecutive patients with discogenic upper back pain underwent coblation procedures on the cervical disk with a percutaneous anterior approach. Pain visual analogue scale (VAS) scores, patient responses stating significant (≥50%) pain relief, significant (≥50%) reduction in pain medicine intake and Modified MacNab criteria were adopted to evaluate the pain intensity, degree of pain relief, and functional status after 12 months of follow-up.The preoperative pain VAS score was 6.5 ± 1.1 (95% confidence interval [CI] 6.085–6.915), and the pain VAS score significantly decreased to 2.4 ± 1.3 (95% CI 1.929–2.928), 2.5 ± 1.5 (95% CI 1.963–3.109), 2.7 ± 1.4 (95% CI 2.157–3.271), 3.1 ± 1.6 (95% CI 2.457–3.686), and 3.1 ± 1.6 (95% CI 2.471–3.743) at 1 week and 1, 3, 6, and 12 months postoperatively, respectively (P < 0.05). Twenty-two (78.6%), 21 (75.0%), 20 (71.4%), 19 (67.9%), and 18 (64.3%) of the patients expressed significant pain relief at 1 week and 1, 3, 6, and 12 months postoperatively, respectively. 24 (85.7%), 23 (82.1%), 23 (82.1%), and 22 (78.6%) reported significant reduction in pain medication intake at 1, 3, 6, and 12 months postoperatively, respectively. According to the Modified MacNab criteria, the numbers of patients with “excellent” or “good” ratings were 22 (78.6%), 21 (75.0%), 20 (71.4%), and 18 (64.3%) at 1, 3, 6, and 12 months postoperatively, respectively. No serious complications were observed.The findings of this study showed that coblation is an effective, safe, minimally invasive, and less uncomfortable procedure for the treatment of discogenic upper back pain.

Computed Tomography‐Guided Percutaneously Controlled Ablation of the Thoracic Paravertebral Nerve Due to Thoracic Neuropathic Pain

“…The tiny pieces are then removed through the tunnel of an introducer needle, which results in a volumetric removal of the target tissue and the creation of a lower pressure region. Coblation has been used for the treatment of discogenic pain, painful bone diseases, and Achilles tendinosis . Although coblation has been successful in alleviating discogenic pain, with the majority of patients achieving excellent clinical outcomes, to date, only 1 case of phantom limb pain has been treated successfully with coblation …”

Effect of intradiscal pulsed radiofrequency on refractory chronic discogenic neck pain

“…[ 30 ] Minimally invasive intradiscal procedures, such as percutaneous laser decompression and RF, have been used to denervate nociceptive nerve fibers in the cervical disc. [ 31 ] However, high temperatures during these procedures can shrink the disc. [ 32 ] Conversely, the targeted tissue temperature is maintained at or below 42°C during PRF procedures.…”

Cervicogenic headache alleviation after cervical coblation nucleoplasty

“…Although the pathological mechanism of lower cervical disc involvement in CEH is unclear, the positive outcomes in this study are possibly due to the following: nucleoplasty resulted in decompression of the lower cervical nerve root [19] because pain afferents from the lower cervical root possibly converge on the trigeminocervical nucleus, which was indicated by open lower cervical surgery [13] ; nucleoplasty resulted in the ablation of nociceptors that innervated the lower cervical disc, [20,24] because nociceptive afferents in the lower cervical disc possibly converge onto the trigeminocervical nucleus through C2–C3 DRG, which was found by an immunohistological analysis of the cervical disc [25] ; and nucleoplasty possibly produced an indirect effect in improving spinal kinesthetics in the higher cervical spine, which is less likely to be important in mediating headache relief. [20] …”