The authors concluded that there are few high quality studies evaluating non-operative treatments for reducing discogenic LBP. An assessment by the National Institute for Clinical Excellence (2004) concluded: "Current evidence on the safety and efficacy of percutaneous disc decompression using Coblation for lower back pain does not appear adequate to support the use of this procedure without special arrangements for consent and for audit or research. Nakajima H, Kubota A, Maezawa Y, et al. It can be difficult to determine who will benefit from spinal decompression surgery. Daniel, D.M. Technical Brief Prepared for AETMIS. Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats, Bird Flu Deaths Prompt U.S. to Test Vaccine in Poultry, COVID Treatment in Development Appears Promising, Marriage May Help Keep Your Blood Sugar in Check, Getting Outdoors Might Help You Take Fewer Meds, New Book: Take Control of Your Heart Disease Risk, MINOCA: The Heart Attack You Didnt See Coming, Health News and Information, Delivered to Your Inbox. The most common side effects at 24 hours post-procedure was soreness at the needle insertion site (76 %), new numbness and tingling (26 %), increased intensity of pre-procedure back pain (15 %), and new areas of back pain (15 %). PIRFT is performed using the Radionics RF Disc Catheter System or the DiscTRODE. background-color: #cc0066; The authors concluded that they demonstrated that intradiscal injection of autologous PRP releasate in patients with LBP was safe, with no AEs observed during follow-up. Original 510(k) clearance was obtained by Oratec Interventions, Inc., (Menlo Park, CA). Now you have a proven alternative to invasive procedures like surgery or epidural injections. 2012;15(2):E115-E129. Of these, 3 RCTs and 1 observational study met the inclusion criteria. IDET - Intradiscal electrothermal therapy for treatment of back pain. The 11 RCTs investigated traction therapy, injections and ablative techniques. Effectiveness of intradiscal electrothermal therapy in increasing function and reducing chronic low back pain in selected patients. Available at: http://www.emedicine.com/neuro/topic707.htm. Short-term effectiveness was defined as 1-year or less and long-term effectiveness was defined as greater than 1-year. A greater than or equal to 50 % NRS reduction was observed in 52 % (95 % confidence interval [CI]: 31 % to 74 %) and 44 % (95 % CI: 22 % to 69 %) of subjects in the C-RFA and T-RFA groups, respectively (p = 0.75). 2015;18(2):E217-E223. The main outcome measures evaluated were the percentage of pain relief based on VAS or numeric rating scale (NRS), percentage of patients with more than 50 % reduction in pain, percentage of patients meeting one or more success criteria after Nucleoplasty, and improvement in patient function. After 2 weeks, it was reduced to 3.2 0.6 (p < 0.001) and finally dropped to 2.0 0.6 6 months after intervention (p = 0.0001). Investigators did not compare the effectiveness of VAX-D against subjects who received no treatment, placebo treatment, or some other type of treatment. Spinal stenosis can cause a number of annoying symptoms that can get worse over time. In addition, the lack of a comparison group for conservative therapies in the course of symptoms was another drawback for which future multi-center studies with comparison groups are recommended to further ascertain the safety, efficacy, and effectiveness of PLDD and intradiscal injection of DiscoGel in discopathy. The developers of this procedure have commented that long-term studies and randomized controlled clinical trials are needed to validate the effectiveness of IDET (Saaland Saal, 1999): "Further study is necessary to define the mechanism and reasons for clinical improvement. The treatment options range from physiotherapy to fusion surgery. For MSCs, the aggregate success rate at 6 months was 53.5 % (95 % CI: 38.6 % to 68.4 %), though using worst-case analysis this decreased to 40.7 % (95 % CI: 28.1 % to 53.2 %). A critique of this systematic evidence review by the Centre for Review and Dissemination (2010) noted that theresults were mainly extracted from observational studies in settings where the studied procedure was performed routinely; hence there was a bias risk in favor of the procedure (this limitation was acknowledged by the authors). Idk. London, UK: NICE; May 2004. Dumb!" Azulay and colleagues (2008) assessed a technique for radiofrequency heating of the lumbar intervertebral disc by a needle placed into the nucleus pulposus. 702 - Section 8 & 15-Accepted And Acknowledged. The disarticulated cervical spines from4 fresh frozen cadavers were studied. Typically they're less obese, have less [spinal] degeneration going on, more abdominal strength and better flexibility," he says. Intradiscal electrothermal therapy for chronic discogenic back pain -- horizon scanning review. Efficacy, safety, and predictors of intradiscal methylene blue injection for discogenic low back pain: Results of a multicenter prospective clinical series. Waltham, MA: UpToDate; reviewed April 2020. In a prospective, multicenter pilot study, Kelekis et al (2021) compared the non-inferiority treatment status and clinical outcomes of intradiscal O2-O3 with microdiscectomy in patients with refractory radicular leg pain due to single-level contained lumbar disc herniations. According to inclusion and exclusion criteria, 480 articles were considered as relevant for the purpose of this systematic review. Twelve-month analgesia and rescue, by cooled radiofrequency ablation treatment of osteoarthritic knee pain: Results from a prospective, multicenter, randomized, cross-over trial. Mean post-treatment pain scores at months 1 and 6 were significantly lower (p < 0.01) in both groups, and between-group differences were not significant. A total of 209 patients with protrusive lumbar disc herniation underwent percutaneous ablation decompression treatment using an intradiscal routable electrode (L-Disq) in the authors pain clinic; VAS and ODI scores were recorded at the beginning and at the 1st, 3rd, 6th, and 12th months following treatment. Overgrowth of bone, tumor growth, or herniated discs can also lead to the development of spinal stenosis. Akeda K, Takegami N, Yamada J, et al. right: 30px; Groups A and B were evaluated regarding the pain score (VAS; 0 to 10), before the interventional procedures, and 1, 3, 6, and 12 months afterwards. A prospective cohort design or a non-randomized prospective design is used with a biased control. All of these interventions aim at relieving pressure from compressed nerve roots by mechanical ablation, chemical dissolution, evaporation or coagulation of disc tissue. Papadopoulos D, Batistaki C, Kostopanagiotou G. Comparison of the efficacy between intradiscal gelified ethanol (Discogel) injection and intradiscal combination of pulsed radiofrequency and gelified ethanol (Discogel) injection for chronic discogenic low back pain treatment. structures in the back (the "cushion" disks and vertebral bones), Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats, Bird Flu Deaths Prompt U.S. to Test Vaccine in Poultry, COVID Treatment in Development Appears Promising, Marriage May Help Keep Your Blood Sugar in Check, Getting Outdoors Might Help You Take Fewer Meds, New Book: Take Control of Your Heart Disease Risk, MINOCA: The Heart Attack You Didnt See Coming, Health News and Information, Delivered to Your Inbox, Arthritis & Ankylosing Spondylitis of the Spine, Injections for Back Pain: What You Need to Know, Prevention: The Future of Migraine Therapy, VAX-D: Treating Back Pain Without Surgery. Pettine and colleagues (2017) evaluated the safety and feasibility of intradiscal bone marrow concentrate (BMC) injections for the treatment of low back discogenic pain as an alternative to surgery with 3 years minimum follow-up. Patients with positive diagnostic MBN blocks (greater than 75 % relief) were randomized to MBN C-RFA or T-RFA. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria for interventional techniques for randomized trials, and the criteria developed by the Newcastle-Ottawa Scale criteria for observational studies. Intradiscal electrothermal therapy (IDET) for the treatment of chronic, discogenic low back pain. Sciatica most commonly occurs when a herniated disk, bone spur on the spine or narrowing of the spine (spinal stenosis) compresses part of the nerve. The limitations of this portion of the study were that the remaining IAS group sample size was not large enough to carry out statistical test-based comparisons between the originally treated C-RFA patients and the IAS group members at 12 months, outcomes of the originally treated C-RFA group and those of the crossed-over cohort could not be directly compared at 6 months, because the groups were derived from 2 different study populations, and an effect of C-RFA on opioid use could not be detected, perhaps due to alternate patient conditions that also utilized opioids as therapy. There were no significant differences in demographic variables (p > 0.05). background-color:#eee; Group B appeared to be more effective, with a statistically significant difference, compared with group A regarding the secondary objectives of the study. These researchers stated that a large, double-blinded, randomized study would be helpful in confirming these findings. Kvarstein G, Mwe L, Indahl A, et al. Sciatica, generally speaking, is caused by inflammation of the sciatic nerves which run from the spinal column down through each of the legs. Cochrane Database Syst Rev. Larger scale population studies are needed to provide further evidence to validate these findings. Primary outcome was overall 6-month improvement over baseline in leg pain. Saal JA, Saal JS. Improvements in functional capacity and pain scores were noted in 2 patients. P/N 07817. She underwent surgical drainage and irrigation. The Nerve & Disc Institute is owned by Solomon L. Cogan, D.C. 2022 The Nerve & Disc Institute. Anyone know of their reputation for helping clients? Trials of automated percutaneous discectomy suggested that clinical outcomes after treatment are at best fair and often worse when compared with microdiscectomy. These practices vary from clinic-to-clinic and patient-to-patient, which reflects real-world application, and even in a research setting it is challenging to maintain standardized protocols. Bloomington, MN: ICSI; 2005. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Rosemont, IL: AAOS; March 2002. 2002;27(9):966-973; discussion 973-974. The Refined Approach [website]. Pain Physician. Surgery may help relieve symptoms from pressure on the spinal cord or nerves, including: Your doctor may suggest one or more types of back surgeries to relieve the pressure in your spine. Differences in secondary measures favored IDB; no differences in opioid utilization were noted between groups. Daste C, Laclau S, Boisson M, et al. The authors concluded that fluoroscopy-guided infiltrations of intervertebral discs and facet joints with PRGF in patients with chronic LBP resulted in significant pain reduction assessed by VAS. Pain Pract. Though he claims a high success rate with VAX-D -- between 70% and 80% -- he acknowledges that not all patients achieve optimal outcomes. The lack of data makes it difficult to draw conclusions regarding the efficacy of the procedure. 2002;27(22):2621-2626. This review was intended to reveal the research status of silk-based scaffolds in the musculoskeletal system within the recent decade. Case Rep Orthop. position: fixed; More importantly, the procedure demonstrated a strong safety profile with no SAEs or complications linked to the therapy. The original IDB + CMM study subjects were followed for a total of 12 months (n = 22). Three patients had recurrence within a week of the procedure. Both groups received lidocaine hydrochloride injections for pain associated with the procedure. In patients 1 and 3, ODI 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. A blinded interim analysis was performed when 20 patients had been followed for6 months. State of Oregon Workman's Compensation System Medical Advisory Committee The IDET procedure. Secondary measures noted were reports of complications and the Quality Index scores of each study that was evaluated. Subjects were asked regarding their NRS scores, ODI scores, and progression to secondary treatment. Furthermore, 50 % and 64 % of subjects reported clinically significant improvements in SF36-PF and in ODI, respectively. Any case studies, results, endorsements, or testimonials presented on this page reflect the personal experience and opinions of the individual patient and do not prove our treatment works. Pain Physician. Zhang X, Hao J, Hu Z, Yang H. Clinical evaluation and magnetic resonance imaging assessment of intradiscal methylene blue injection for the treatment of discogenic low back pain. In all cases, their condition was refractory to initial conservative care and 1 epidural steroid injection had failed. Marin (2005) stated that Nucleoplasty may be an effective minimally invasive technique for the treatment of symptoms associated with contained herniated disc. ( k ) clearance was obtained by Oratec Interventions, Inc., ( Menlo Park, ). These, 3 RCTs and 1 observational study met the inclusion criteria this systematic review that can get over... Of data makes it difficult to determine who will benefit from spinal decompression surgery with a control. Injections and ablative techniques to intradiscnutrosis what is it surgery % of subjects reported clinically significant in... The lack of data makes it difficult to draw conclusions regarding the efficacy of the procedure further to. Were noted between groups was evaluated ; More importantly, the procedure recent decade procedures surgery. And 64 % of subjects reported clinically significant improvements in functional capacity and pain scores noted. 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