Intradiscal biacuplasty (IDB) for the treatment of thoracic discogenic pain.
OBJECTIVE
Discogenic pain in the thoracic region is a challenging condition characterized by refractoriness to conservative treatments. Unlike lumbar discogenic pain there is a lack of effective surgical options. Reported here is the treatment of thoracic discogenic pain in 3 patients using a new minimally invasive procedure named intradiscal biacuplasty.


METHODS
Clinical case series in outpatient clinical setting. The procedure is detailed and step-by-step fluoroscopic imaging is presented.


RESULTS
No intraoperative and postoperative complications were reported. Improvements in functional capacity and pain scores were noted in 2 patients. Visual analog scale pain scores changed from 10 to 2 cm and 7 to 3 cm in 2 patients who claimed improvements at 12 months follow-up. In patient 1 visual analog scale went from 7 to 8 cm claiming no improvements after the procedure. In patients 1 and 3, Oswestry Disability Index improved from 24 to 8 and 10 points, respectively, and SF-36 physical function score changed from 55 to 80 and 45 to 82, respectively. The patient 2 showed no improvements with Oswestry (28 to 32) and SF-36 physical function score (50 to 45) at 12 months after intradiscal biacuplasty. Patient 1 stopped using his oxycodone/acetaminophen 5/325 mg that he used previously at 6 tablets a day, patient 3 decreased use of his duragesic patch from 75 microg/h to 25 microg/h. Patient 2 continued with significant use of opioids (100 microg/h of transdermal fentanyl).


CONCLUSIONS
Cooled, bipolar radiofrequency may be an effective and readily available treatment for thoracic discogenic pain if future comparison studies show benefits of such procedure.
Kapural
Leonardo
L
Department of Pain Management, Cleveland Clinic, Cleveland, OH 44195, USA. Kapural@ccf.org
Sakic
Katarina
K
Boutwell
Kaylea
K
D000328:Adult; D004185:Disability Evaluation; D017587:Diskectomy, Percutaneous / Q000379:methods*; D004558:Electric Stimulation / Q000379:methods*; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000150:complications / Q000601:surgery*; D010147:Pain Measurement / Q000379:methods; D016896:Treatment Outcome