Patient Selection and Efficacy of Intradiscal Electrothermal Therapy with Respect to the Dallas Discogram Score.
OBJECTIVE
Intervertebral disc degeneration can cause severe low back pain. Intradiscal electrothermal therapy (IDET) is a minimally invasive treatment option for patients with symptomatic internal disc disruption unresponsive to conservative medical care. We aimed to evaluate 12-month pain and functional outcomes and predictors of clinical success in patients with discogenic back pain treated with IDET with respect to the Dallas Discogram Scale (DDS).


METHODS
This was a retrospective analysis of patients undergoing IDET for low back pain from 2009 through 2014 at Baskent University, Department of Neurosurgery. A total number of 120 consecutive patients data were collected retrospectively. The degree of disc degeneration was graded using the DDS during discography, and the presence of a high intensity zone (HIZ) on magnetic resonance (MR) imaging was noted. The primary outcome measure was assessment of back pain severity based on the Visual Analogue Scale (VAS); function was assessed by the Oswestry Disability Index (ODI). Follow-up examinations for ODI and VAS scores were assessed at 1, 6, and 12 months post-treatment. Outcomes were discussed with respect to morphological changes in intervertebral discs on discogram.


RESULTS
There was an average 57.39% and 47.16% improvement in VAS and ODI scores, respectively, between pretreatment and 12 months follow-up (p < 0.0001 for both comparisons). Predictors of 12-month clinical success was depended on DDS (p < 0.0001), a HIZ on MR imaging (p < 0.0001).


CONCLUSIONS
Durable clinical improvements can be realized after IDET in select surgical candidates with mild disc degeneration and HIZ, discography, and low-grade DDS, with more effective treatment results.
Baskent University, Faculty of Medicine, Department of Neurosurgery, Ankara, Turkey.
Atilla
A
Kircelli
Ilker
I
Coven
Tufan
T
Cansever
Erkin
E
Sonmez
Cem
C
Yilmaz
D000328:Adult; D004599:Electric Stimulation Therapy; D005260:Female; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D017116:Low Back Pain / Q000150:complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D008297:Male; D010147:Pain Measurement; D018579:Patient Selection; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult