Intradiscal thermal annuloplasty versus intradiscal radiofrequency ablation for the treatment of discogenic pain: a prospective matched control trial.
OBJECTIVE
Two minimally invasive techniques have been used more recently as a possible treatment for painful internal disk disruption (IDD). Intradiscal thermal annuloplasty (IDTA), known as IDET, has already shown promising results in pain reduction and functional restoration. The second technique, radiofrequency posterior annuloplasty (RFA), is used in many interventional pain practices, although studies on the technique's efficacy are lacking. This study compares the effectiveness of those two methods.


METHODS
We matched 42 patients (21 had IDTA and 21 radiofrequency annuloplasty) for age, sex, weight, smoking history, manual labor, and number of intervertebral disks treated. Enrolled patients completed pain disability index (PDI) questionnaires before receiving either IDTA or RFA; at 2 weeks; and 2, 3, 6, 9, and 12 months following either treatment.


RESULTS
From the third to the twelfth month after the procedure, the IDTA group had significantly lower mean pain scores than the RFA group. Visual analog scale (VAS) pain scores decreased from 6.6 +/- 2.0 before to 4.4 +/- 2.4 at 1 year after radiofrequency annuloplasty (P = 0.001), while in the IDTA group the average VAS pain score decreased from 7.4 +/- 1.9 before IDTA to 1.4 +/- 1.9 at 1 year follow-up. Similarly, PDI scores in the IDTA group had a significantly larger improvement than those for patients who received radiofrequency annuloplasty.


CONCLUSIONS
This study shows significant improvement in pain scores and patients' PDI following IDTA but not after RFA of the intervertebral disks. IDTA appears to be more efficacious than RFA based on PDI and VAS scores measured at 1 year following procedure.
Kapural
Leonardo
L
Department of Pain Management, The Cleveland Clinic FoundatioN, Cleveland, Ohio 44195, USA. kapural@ccf.org
Hayek
Salim
S
Malak
Osama
O
Arrigain
Susana
S
Mekhail
Nagy
N
D000328:Adult; D000368:Aged; D017115:Catheter Ablation / Q000379:methods*; D002908:Chronic Disease; D017586:Diskectomy / Q000379:methods*; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D007403:Intervertebral Disc / Q000601:surgery*; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000628:therapy*; D017116:Low Back Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D016896:Treatment Outcome