Radiofrequency Lesioning Using Two Different Time Modalities for the Treatment of Lumbar Discogenic Pain: A Randomized Trial

Pain Management Department, VKV American Hospital, Istanbul, Turkey.
Spine (Impact Factor: 2.3). 10/2003; 28(17):1922-7. DOI: 10.1097/01.BRS.0000083326.39944.73
Source: PubMed


A prospective randomized trial.
To evaluate the efficacy of percutaneous intradiscal radiofrequency thermocoagulation by modifying the duration of heating, using two different time methods, for relieving pain and improving functional disability.
Lumbar discogenic pain is the major problem in lumbar degenerative disc disease that percutaneous intradiscal radiofrequency thermocoagulation has been suggested for as a nonsurgical invasive treatment technique for lumbar discogenic pain. In a previous controlled study, this method was found to be ineffective with 8 weeks of follow-up.
Sixty patients with chronic low back pain were selected for provocative discography to diagnose the discogenic pain and to locate the discs to be treated. From this group, 39 patients were randomly selected and divided into two groups. In the first group, treatment was performed for 120 seconds, and in the second group for 360 seconds, both at 80C. Patients were assessed with a visual analogue scale for pain relief and functional improvement. Evaluations were performed before, immediately after treatment, at 1 and 2 weeks, and at 1, 3, and 6 months after the procedure.
A total of 39 patients with positive provocative discographies were found to eligible for the study. There were no statistical differences in pain relief and functional improvement between two groups (P > 0.05). The immediate, 1-week and 2-week, and 1-month visual analogue scale (VAS) scores were decreased significantly in both groups when comparing them with the pretreatment scores (P < 0.05). However, the final values after 6 months were similar to those measured at the beginning of the study (P > 0.05).
Percutaneous intradiscal radiofrequency thermocoagulation has been suggested and performed to relieve discogenic pain. In the previous controlled study, no effective pain relief has been obtained. In this study, the authors increased the duration of radiofrequency thermocoagulation to improve the effectiveness of this method. Yet, the authors have not found any significant differences between the application of lesioning at two different times in percutaneous intradiscal radiofrequency thermocoagulation.

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    • "Less invasive methods were developed with the intention to denervate the observed pathological ingrowth of nerve fibres into the dorsal AF by thermocoagulation. Techniques like PIRFT (percutaneous intradiscal radiofrequency thermocoagulation) or IDET (intradiscal electrothermal therapy) are still performed, although there is only low quality evidence regarding effectiveness and possible complications such as radiculopathy and infection (Ercelen et al., 2003; Freeman et al., 2005; Kvarstein et al., 2009; Pauza et al., 2004). A less destructive, regenerative treatment is in clear clinical demand, though such a therapy would also have to address the problem of pathological innervation. "
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    • "A total of 166 patients were treated, with a satisfactory clinical response of 3-6 months. Five retrospective trials reported on patients with different pain syndromes; in total, 343 patients were treated, with satisfactory results (30-33). Fifteen reviews, editorials, letters, and comments that have discussed the use of PRF have been located (34-42). "
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    • "randomization ?; treatment allocation ?; baseline similarity -; patients blinded ?; care providers blinded -; outcomes blinded ?; co-interventions ?; compliance ?; drop outs ?; timing of outcomes ?; intention-to-treat ?. Total score = 6 Study: Ercelen 2003 "
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