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.
"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. "
[Show abstract][Hide abstract] ABSTRACT: Lumbar discectomy is the surgical procedure most frequently performed for patients suffering from low back pain and sciatica. Disc herniation as a consequence of degenerative or traumatic processes is commonly encountered as the underlying cause for the painful condition. While discectomy provides favourable outcome in a majority of cases, there are conditions where unmet requirements exist in terms of treatment, such as large disc protrusions with minimal disc degeneration; in these cases, the high rate of recurrent disc herniation after discectomy is a prevalent problem. An effective biological annular repair could improve the surgical outcome in patients with contained disc herniations but otherwise minor degenerative changes. An attractive approach is a tissue-engineered implant that will enable/stimulate the repair of the ruptured annulus. The strategy is to develop three-dimensional scaffolds and activate them by seeding cells or by incorporating molecular signals that enable new matrix synthesis at the defect site, while the biomaterial provides immediate closure of the defect and maintains the mechanical properties of the disc. This review is structured into (1) introduction, (2) clinical problems, current treatment options and needs, (3) biomechanical demands, (4) cellular and extracellular components, (5) biomaterials for delivery, scaffolding and support, (6) pre-clinical models for evaluation of newly developed cell- and material-based therapies, and (7) conclusions. This article highlights that an interdisciplinary approach is necessary for successful development of new clinical methods for annulus fibrosus repair. This will benefit from a close collaboration between research groups with expertise in all areas addressed in this review.
European cells & materials 01/2013; 25:1-21. · 4.89 Impact Factor
"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). "
[Show abstract][Hide abstract] ABSTRACT: Low back disorder is the most common problem in the entire spinal axis. About two-thirds of adults suffer from low back pain (LBP) at some time. Pain generators in the lumbar spine include the annulus of the disc, the posterior longitudinal ligament, a portion of the dural membrane, the facet joints, the spinal nerve roots and ganglia, and the associated paravertebral muscle fascia. There is no doubt that the facet joint is a potential source of chronic LBP. Facet joints are true synovial joints that have a joint space, hyaline cartilage surfaces, a synovial membrane, and a fibrous capsule. Two medial branches of the dorsal rami innervate the facet joints. If conservative measures fail in the treatment of facet joint pain, pulsed radiofrequency (PRF) of the medial branches can be administered.
Anesthesiology and Pain Medicine 01/2012; 1(3):168-73. DOI:10.5812/kowsar.22287523.2854
[Show abstract][Hide abstract] ABSTRACT: Injection therapy and denervation procedures are commonly used in the management of chronic low-back pain (LBP) despite uncertainty regarding their effectiveness and safety. To provide an evaluation of the current evidence associated with the use of these procedures, a systematic review was performed. Existing systematic reviews were screened, and the Cochrane Back Review Group trial register was searched for randomized controlled trials (RCTs) fulfilling the inclusion criteria. Studies were included if they recruited adults with chronic LBP, evaluated the use of injection therapy or denervation procedures and measured at least one clinically relevant outcome (such as pain or functional status). Two review authors independently assessed studies for eligibility and risk of bias (RoB). A meta-analysis was performed with clinically homogeneous studies, and the GRADE approach was used to determine the quality of evidence. In total, 27 RCTs were included, 14 on injection therapy and 13 on denervation procedures. 18 (66%) of the studies were determined to have a low RoB. Because of clinical heterogeneity, only two comparisons could be pooled. Overall, there is only low to very low quality evidence to support the use of injection therapy and denervation procedures over placebo or other treatments for patients with chronic LBP. However, it cannot be ruled out that in carefully selected patients, some injection therapy or denervation procedures may be of benefit.
European Spine Journal 09/2010; 19(9):1425-49. DOI:10.1007/s00586-010-1411-0 · 2.07 Impact Factor
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