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

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>There was an average 68 and 66% improvement in back pain and function, respectively, between pretreatment and 24 months after treatment (p &lt; 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 &lt; 0.0001), a high-intensity zone on MR imaging (p = 0.0003), low Pfirrmann grade (p = 0.0002), and more extensive anulus coverage (p &lt; 0.0001). There were no procedure-related adverse events.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>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.</jats:p></jats:sec>

Lasers in orthopaedic surgery

“…92 Despite the fact that PLDD has been used for about 25 years, and its success rates in the larger studies varied from 75% to 87%, scientifi c proof of its effi cacy still remains relatively poor. 93 Destructive methods in the treatment of chronic discogenic pain (including PLDD) may lead to the development of fi brous scar tissue in the disc cavity, which favours the formation and persistence of the pain generator in the disc lesion. Secondary effects and pain return can be observed 1 or 2 years after surgery.…”

“…Secondary effects and pain return can be observed 1 or 2 years after surgery. 93 Therefore the search for the new effective and safe methods for treatment of spine disc diseases is essential.…”

Thermal-Induced Osteonecrosis of Adjacent Vertebra after Intradiscal Electrothermal Therapy

“…Intradiscal electrothermal therapy (IDET) is a minimally invasive procedure that is an intermediate, safe, and effective intervention in the continuum of care for patients with discogenic low back pain1,7,12). IDET has been a popular choice for the treatment of chronic discogenic back pain since its introduction in the year 20007,12).…”

“…IDET has been a popular choice for the treatment of chronic discogenic back pain since its introduction in the year 20007,12). Since the IDET procedure uses a fluoroscopically guided thermal catheter to heat the intervertebral disc, several complications related to thermal injury have been reported1,7,12). Thermal nerve injury is especially common, and thermal bone injury can also be induced rarely by IDET.…”

Patient selection and efficacy of intradiscal electrothermal therapy with respect to dallas discogram score

“…IDET involves using a navigable intradiscal catheter that is radiologically guided into the outer posterior and posterolateral AF across a previously identified tear, and has the ability to treat patients with lumbar disc annular disease that have been unresponsive to conservative management (4,6,7). A temperature-controlled thermal resistive coil provides conductive heating of the AF in a range that leads to denatur-IDET procedure in only a select group of patients.…”