Treatment Of Chronic Discogenic Pain Research Articles

Acute Histologic Effects and Thermal Distribution Profile of Disc Biacuplasty Using a Novel Water-Cooled Bipolar Electrode System in anIn vivoPorcine Model

Thermal treatment of the lumbar intervertebral disc has been suggested for the treatment of chronic discogenic pain. Disc biacuplasty (D-BAC) is a novel procedure that uses two water-cooled radiofrequency electrodes in a bipolar configuration to heat a large volume of the posterior annulus fibrosus. Seven porcine lumbar discs were treated with D-BAC to assess acute effects on the treated tissue in a "worst-case"in vivo model. Intradiscal and peridiscal temperatures were measured during treatment and histologic analysis was used to assess for evidence of acute thermal injury. Temperature monitoring at designated safety zones outside the disc demonstrated maintenance of near-physiologic conditions while temperature in the inner posterior annulus reached 65 degrees C. Histologic sections of treated discs demonstrated no evidence of thermal damage to the dorsal root ganglia or spinal nerve roots when compared with controls. Increased coarseness of the fibrillar matrix and loss of cellular detail were noted in the nucleus pulposus of treated discs. Disc biacuplasty, in a porcine model, achieves suitable temperatures to induce thermal transition of collagen and thermoneurolysis while showing no evidence of damage to neural tissue in safety zones surrounding the disc.

Outcomes of Percutaneous Disc Decompression Utilizing Nucleoplasty for the Treatment of Chronic Discogenic Pain

Background: Percutaneous disc decompression utilizing Nucleoplasty has emerged as one of the minimally invasive techniques for treatment of low back pain and lower extremity pain due to contained herniated discs. Only 1 study to date has examined its effect on functional activity and pain medication use; however, results were not analyzed over time, and recall bias was a limitation. Objective: Evaluation of the effect of Nucleoplasty on pain and opioid use in improving functional activity in patients with radicular or axial low back pain secondary to contained herniated discs. Design: Retrospective, non-randomized case series. Methods: Twenty-two patients who had undergone Nucleoplasty were included in the analysis. Patients were evaluated at 1, 3, 6, and 12 months postoperatively, and were asked to quantify their pain using a visual analog scale ranging from 0 to 10. Patients were also surveyed in regards to their pain medication use, and functional status was quantified by a physical therapist who also used patient reports of ability to perform activities of daily living to assess status. Data were compared between baseline and at 1, 3, 6, and 12 months posttreatment. Results: Reported pain and medication use were significantly decreased and functional status was improved at 1, 3, 6, and 12 months following Nucleoplasty (P values ≤ 0.0010 for all outcome measures at all time periods). There were no complications associated with the procedure and we found continued improvements over time. Conclusion: Nucleoplasty appears to be safe and effective. Randomized, controlled studies are required to further evaluate its long-term efficacy. Key words: Discectomy, disc herniation, low back pain, minimally invasive, Nucleoplasty, percutaneous disc decompression.

Percutaneous Disc Decompression Using Coblation (NucleoplastyTM) in the Treatment of Chronic Discogenic Pain

Clinical outcome data was analyzed for 67 patients with contained disc herniation who underwent percutaneous disc decompression procedure using Coblation(R) technology, also referred to as Nucleoplasty after failing to respond to conservative management. Patients presented with clinical symptoms of discogenic low back pain and/or leg pain and were not considered candidates for open surgery. Follow-up data was collected up to 12 months. Patient gender distribution was 70% female, 30% male, with a mean age of 44 years. The onset of the pain was predominantly of nontraumatic origin with an average duration of pain of 5.4 years ranging from 4 months to 29 years with history of previous surgical intervention in 13% of the patients. At 1 year, 80% of the patients demonstrated statistically significant improvement in numeric pain scores. Average pre-procedure pain level for all patients was reported as 6.8 while average pain level was 4.1 at the 12 month follow-up period. Statistically significant improvement was observed in 62%, 59%, and 60% of patients in sitting, standing, and walking ability at 12 months, respectively. The results of this analysis indicated that PDD using Coblation technology, also referred to as Nucleoplasty, is an effective procedure for patients presenting with discogenic back and/or leg pain who have failed conservative therapies and are not considered candidates for open surgical interventions.