Abstract
Discogenic low back pain is a pervasive, disabling, and costly problem. Internal disc disruption accounts for approximately 40% of all patients who have the chief symptom of axial low back pain. The majority of episodic back pain will resolve without specific treatment. Unfortunately, pain may persist in spite of comprehensive conservative care. Historically, a gulf has existed between the standard conservative treatments of physiotherapy, medication, cognitive therapy, and therapeutic injection and the more aggressive surgical interventions such as fusion. To bridge this gap, percutaneous techniques have been developed to deliver thermal energy to the disc. Heating of the intervertebral disc is hypothesized to decrease nocioception by coagulation of annular nocioceptors, modification of annular collagen, and physiochemical effect on nuclear inflamagens. Success has been reported in clinical trials of intradiscal electrothermal annuloplasty. Single needle intradiscal radiofrequency is clinically ineffective, but a new means of delivering radiofrequency-induced thermal energy to the posterior annulus is now available. Despite clear and increasing interest in percutaneous disc heating, little data is available on in vivo annular thermometry. The thermal dose (temperature × time) required to provide a consistent clinical response is unknown. Thorough knowledge of in vivo annular temperatures achieved with the different heating strategies is necessary to optimize existing technology, safely develop new techniques, and understand mechanisms underlying thermal modulation of discogenic pain. This study reports annular thermometry data obtained in sheep and humans during application of electrothermal conductive and ionic heating to the intervertebral disc. Included are data from the first 4 human intervertebral discs treated with the radiofrequency catheter ionic heating. Copyright © 2001 by W.B. Saunders Company
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