Lumbar Degenerative Disease Part 1: Anatomy and Pathophysiology of Intervertebral Discogenic Pain and Radiofrequency Ablation of Basivertebral and Sinuvertebral Nerve Treatment for Chronic Discogenic Back Pain: A Prospective Case Series and Review of Literature.

Hyeun Sung Kim,Il-Tae Jang,Pang Hung Wu

doi:10.3390/ijms21041483

Hyeun Sung Kim, Il-Tae Jang + Show 1 more

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https://doi.org/10.3390/ijms21041483

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Abstract

Degenerative disc disease is a leading cause of chronic back pain in the aging population in the world. Sinuvertebral nerve and basivertebral nerve are postulated to be associated with the pain pathway as a result of neurotization. Our goal is to perform a prospective study using radiofrequency ablation on sinuvertebral nerve and basivertebral nerve; evaluating its short and long term effect on pain score, disability score and patients’ outcome. A review in literature is done on the pathoanatomy, pathophysiology and pain generation pathway in degenerative disc disease and chronic back pain. 30 patients with 38 levels of intervertebral disc presented with discogenic back pain with bulging degenerative intervertebral disc or spinal stenosis underwent Uniportal Full Endoscopic Radiofrequency Ablation application through either Transforaminal or Interlaminar Endoscopic Approaches. Their preoperative characteristics are recorded and prospective data was collected for Visualized Analogue Scale, Oswestry Disability Index and MacNab Criteria for pain were evaluated. There was statistically significant Visual Analogue Scale improvement from preoperative state at post-operative 1wk, 6 months and final follow up were 4.4 ± 1.0, 5.5 ± 1.2 and 5.7 ± 1.3, respectively, p < 0.0001. Oswestery Disability Index improvement from preoperative state at 1week, 6 months and final follow up were 45.8 ± 8.7, 50.4 ± 8.2 and 52.7 ± 10.3, p < 0.0001. MacNab criteria showed excellent outcomes in 17 cases, good outcomes in 11 cases and fair outcomes in 2 cases Sinuvertebral Nerve and Basivertebral Nerve Radiofrequency Ablation is effective in improving the patients’ pain, disability status and patient outcome in our study.

Highlights

Degenerative disc disease is a leading cause of chronic back pain in the aging population in the world [1]
Mean follow up was 14.9 (6–31) months with mean age of 48 (19–68) years old. They presents with a mean duration of 27 (8–130) months of discogenic back pain. 11 out of 30 of the cases are from L4/5 disc, 15 from L5/S1 and 4 cases had multiple levels of involvement
In 8 cases, Interlaminar Endoscopy Lumbar to Disc Approach was performed with radiofrequency application, in all 8 cases, the diagnosis is degenerated disc protrusion of L5/S1 intervertebral disc with discogenic back pain on top of radicular leg pain. 16 cases of combined Lumbar Endoscopic Unilateral Laminotomy Bilateral Decompression with interlaminar radiofrequency ablation, all of the 16 cases has background mild spinal stenosis marked by thickening of ligamentum flavum with degenerated disc protrusion and predominant discogenic back pain and neuropathic leg pain but no spinal claudication

Summary

Introduction

Degenerative disc disease is a leading cause of chronic back pain in the aging population in the world [1]. Pain generators are postulated to be discogenic origin, recent studies found some association with adjacent vertebral end plates and vertebral bodies, known as modic changes. Sinuvertebral nerve and basivertebral nerve are associated with the pain pathway [7,8,9,10,11,12]. We perform a prospective study using radiofrequency ablation on sinuvertebral nerve and basivertebral nerve and evaluate its short and long term effect on pain score, disability score and patients’ outcome and discuss the pathoanatomy, pathophysiology and pain generation pathway in degenerative disc disease and chronic back pain

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