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

ArticleinSpine 28(17):1922-7 · October 2003with3 Reads
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.
    • "A randomized controlled trial performed by Barendse et al. [5] found that an RF‑induced lesion (generated by a straight RF probe inserted into the center of the disc and heated to 70°C for 90 s) was not effective in reducing discogenic LBP. Ercelen et al. [6] conducted another prospective randomized trial utilizing RF at 80°C for 120 s or 360 s and found that the increased duration of PIRFT failed to improve the effectiveness of treating patients with LBP. The reasons for the poor treatment efficacy are likely very complex. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: The efficacy of percutaneous intradiscal radiofrequency thermocoagulation (PIRFT) for the treatment of discogenic low back pain (LBP) remains controversial. However, all the PIRFT studies utilized monopolar radiofrequency thermocoagulation (RFTC). The aim of this study was to investigate the safety and efficacy of bipolar RFTC for the treatment of discogenic LBP. Methods: A total of 23 patients with discogenic LBP were treated with single-level bipolar RFTC. The patients were assessed before the procedure and at 1 week, 1 month, 3 months, 6 months, and 1 year after the procedure. The primary outcome included the visual analog scale (VAS) score and the Oswestry Disability Index (ODI) score. The secondary outcome included pain relief, reduction of analgesic dose, and patient satisfaction. Results: The VAS and ODI scores were significantly decreased after bipolar RFTC treatment at all time points of follow-up (P < 0.05). Bipolar RFTC treatment also resulted in a significant change in all secondary measures, such as pain relief, reduction of analgesic dose, and patient satisfaction. No serious complications or neurological sequelae were observed in any of the patients. Conclusions: Bipolar RFTC treatment can significantly attenuate pain and improve the function of patients with discogenic LBP.
    Full-text · Article · Oct 2016
    • "Imaging scans are used during radiofrequency neurotomy to help to position the needles. RF is commonly carried out percutaneously and local anaesthesia is sufficient to perform it678910111213. The procedure can be done by placing an electrode (needle) under continuous X-ray guidance in specific target points and passing a high frequency electrical current through the electrode. Pain relief from RF can last from 6 to 12 months and in some cases relief can last for years [14, 15] . "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Radiofrequency is widely used in the treatment of chronic pain for its efficacy and low incidence of side effects and complications. Despite this, it is commonly believed that this kind of treatment could interfere with medical implantable devices. Potential interference between implanted devices such as pacemakers, defibrillators and spinal cord stimulators and the radiofrequency of neurotomy is an important concern for physicians caring for patients with these devices. Methods: A retrospective study was conducted on 30 radiofrequency-treated patients, collected in five years out of more than 1,000 patients treated. Our cohort was selected due to the presence of implanted medical devices. Treatments include the radiofrequency neurotomy of the lumbar facet joints, intervertebral discs, sacroiliac joint and peripheral nerves. Results: Out of 30 patients and 68 treatments, global radiofrequency ablation was considered safe, due to the absence of any problem during or after the procedure. In particular, procedures were never interrupted because of electrical interference with the implanted devices or for problems attributable to an aberrant activation of them. Neurological and physical exam did not show any alteration after the procedure. Conclusion: There are several theoretical concerns about radiofrequency treatments in patients with implantable electrical medical devices. However, there is no experimental evidence of electrical interference with the implanted devices. Our long experience strongly suggests that by following simple precautions, patients can benefit from radiofrequency pain-relieving procedures without any adverse events.
    Full-text · Article · Jul 2014
    • "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.
    Full-text · Article · Jan 2013
Show more