Poster 26: Intradiskal electrothermal therapy for treatment of chronic lumbar diskogenic pain: a minimum 2-year clinical outcome study

Abstract

Objective: To determine the long-term efficacy of intradiskal electrothermal therapy (IDET) in the treatment of chronic lumbar diskogenic pain. Design: Prospective case series clinical outcome study. Setting: Academic-affiliated private physiatry practice. Participants: 62 consecutive patients with chronic diskogenic pain of >6 months in duration and consecutively enrolled in a nonrandomized prospective fashion. Inclusion criteria included constant moderate to severe low back pain (LBP) for >6 months; failure of conservative management; and positive diskogram with or without disk protrusion of <5mm. Exclusion criteria included severe disk space narrowing; disk extrusion or sequestered fragment; severe spinal stenosis; and segmental instability. Intervention: IDET using standard technique and heating protocol. Main Outcome Measures: Visual numeric pain scale (VNS) for LBP and lower-extremity pain, Roland-Morris Disability Questionnaire (RMDQ), and North American Spine Society (NASS) patient satisfaction index. Results: 51 of 62 patients (82%) were available for a minimum of 2-year follow-up. Average age was 41.4 years; average symptom duration was 46 months; and average follow-up was 34 months. Overall, there was statistically significant improvement in LBP VNS, RMDQ, and lower-extremity pain scores of 3.2, 6.6, and 2.3 ( P<.001), respectively. 27 of 51 patients (53%) demonstrated clinically significant VNS and RMDQ improvements of >2. On the NASS index, 63% (32/51) responded positively. Neither the number of disk levels treated nor the insurance status of patients affected outcome. Patients with history of a microdiskectomy (n=3) responded favorably, with mean LBP VNS, RMDQ, and lower-extremity improvement of 6.3, 20.7, and 8.0 ( P<.05), respectively. Those with spondylolisthesis (n=4) did not improve ( P>.05). 68% of patients reported using fewer oral analgesics and 25% reported using the same amount. Conclusion: IDET appears to be an effective treatment for chronic lumbar diskogenic pain in a well-selected group of patients with favorable long-term outcome.