Efficacy of transforaminal laser annuloplasty versus intradiscal radiofrequency annuloplasty for discogenic low back pain
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Background: Discogenic pain is a common cause of disability and is assumed to be a major cause of non- specific low back pain. Various treatment methods have been used for the treatment of discogenic pain. This study was conducted to compare the therapeutic success of radiofrequency (an intradiscal procedure) and laser annuloplasty (both an intradiscal and extradiscal procedure).Methods: This single-center study included 80 patients and followed them for 6 months. Transforaminal laser annuloplasty (TFLA, 37 patients) or intradiscal radiofrequency annuloplasty (IDRA, 43 patients) was performed. The main outcomes included pain scores, determined by the numeric rating scale (NRS), and Oswestry disability index (ODI), at pre-treatment and at post-treatment months 1 and 6.Results: The patients were grouped according to procedure. In all procedures, NRS and ODI scores were significantly decreased over time. 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. The ODI score was also significantly decreased compared with baseline. Among patients undergoing TFLA, 70.3% (n = 26) reported pain relief (NRS scores ＜ 50% of baseline) at post-treatment 6 months, vs. 58.1% (n = 25) of those undergoing IDRA. There were no statistically significant differences between the groups in ODI reduction of ＞ 40%. Conclusions: Our results indicate that annuloplasty is a reasonable treatment option for carefully selected patients with lower back and radicular pain of discogenic origin, and TFLA might be superior to IDRA in patients with discogenic low back pain.
Abstract
Background: Discogenic pain is a common cause of disability and is assumed to be a major cause of non- specific low back pain. Various treatment methods have been used for the treatment of discogenic pain. This study was conducted to compare the therapeutic success of radiofrequency (an intradiscal procedure) and laser annuloplasty (both an intradiscal and extradiscal procedure).Methods: This single-center study included 80 patients and followed them for 6 months. Transforaminal laser annuloplasty (TFLA, 37 patients) or intradiscal radiofrequency annuloplasty (IDRA, 43 patients) was performed. The main outcomes included pain scores, determined by the numeric rating scale (NRS), and Oswestry disability index (ODI), at pre-treatment and at post-treatment months 1 and 6.Results: The patients were grouped according to procedure. In all procedures, NRS and ODI scores were significantly decreased over time. 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. The ODI score was also significantly decreased compared with baseline. Among patients undergoing TFLA, 70.3% (n = 26) reported pain relief (NRS scores ＜ 50% of baseline) at post-treatment 6 months, vs. 58.1% (n = 25) of those undergoing IDRA. There were no statistically significant differences between the groups in ODI reduction of ＞ 40%. Conclusions: Our results indicate that annuloplasty is a reasonable treatment option for carefully selected patients with lower back and radicular pain of discogenic origin, and TFLA might be superior to IDRA in patients with discogenic low back pain.
참고문헌 (25)
- Schwarzer AC, "The prevalence and clinical features of internal disc disruption in patients with chronic low back pain", Spine (Phila Pa 1976), 20, pp.1878~1883 (1995)
- Peng BG, "The pathogenesis of discogenic low back pain", Chin J Surg, 42, pp.720~724 (2004)
- Freemont AJ, "Nerve ingrowth into diseased intervertebral disc in chronic back pain", Lancet, 350, pp.178~181 (1997)
- Peng B, "The pathogenesis of discogenic low back pain", J Bone Joint Surg Br, 87, pp.62~67 (2005)
- Peng B, "Possible pathogenesis of painful intervertebral disc degeneration", Spine (Phila Pa 1976), 31, pp.560~566 (2006)
- Barendse GA, "Randomized controlled trial of percutaneous intradiscal radiofrequency thermocoagulation for chronic discogenic back pain: lack of effect from a 90-second 70C lesion", Spine (Phila Pa 1976), 26, pp.287~292 (2001)
- Kapural L, "Intradiscal thermal annuloplasty versus intradiscal radiofrequency ablation for the treatment of discogenic pain : a prospective matched control trial", Pain Med, 6, pp.425~431 (2005)
- Oh WS, "A randomized controlled trial of radiofrequency denervation of the ramus communicans nerve for chronic discogenic low back pain", Clin J Pain, 20, pp.55~60 (2004)
- Nachemson A, "Lumbar disc disease with discogenic pain. What surgical treatment is most effective?", Spine (Phila Pa 1976), 21, pp.1835~1838 (1996)
- Zhou Y, "Diagnosis and minimally invasive treatment of lumbar discogenic pain--a review of the literature", Clin J Pain, 22, pp.468~481 (2006)
- Khot A, "The use of intradiscal steroid therapy for lumbar spinal discogenic pain: a randomized controlled trial", Spine (Phila Pa 1976), 29, pp.833~836 (2004)
- Lee JH, "Clinical efficacy and its prognostic factor of percutaneous endoscopic lumbar annuloplasty and nucleoplasty for the treatment of patients with discogenic low back pain", World Neurosurg, 105, pp.832~840 (2017)
- Lee JH, "Clinical efficacy of percutaneous endoscopic lumbar annuloplasty and nucleoplasty for treatment of patients with discogenic low back pain", Pain Med, 17, pp.650~657 (2016)
- Lee SH, "Percutaneous endoscopic laser annuloplasty for discogenic low back pain", World Neurosurg, 73, pp.198~206 (2010)
- Kumar N, "Annulo-nucleoplasty using Disc-FX in the management of lumbar disc pathology : early results", Int J Spine Surg, 8, pp.18~ (2014)
- Hellinger S, "Treatment of contained lumbar disc herniations using radiofrequency assisted micro-tubular decompression and nucleotomy : four year prospective study results", Int J Spine Surg, 8, pp.24~ (2014)
- Lee SH, "Trans-sacral epiduroscopic laser decompression for symptomatic lumbar disc herniation : a preliminary case series", Photomed Laser Surg, 34, pp.121~129 (2016)
- Cheng J, "Posterolateral transforaminal selective endoscopic diskectomy with thermal annuloplasty for d iscogenic low back pain: a prospective observational study", Spine (Phila Pa 1976), 39(26 Spec), pp.B60~B65 (2014)
- Derby R, "Intradiscal Electrothermal Annuloplasty(IDET) : a novel approach for treating chronic discogenic back pain", Neuromodulation, 3, pp.82~88 (2000)
- Yu SW, "Tears of the anulus fibrosus : correlation between MR and pathologic findings in cadavers", AJNR Am J Neuroradiol, 9, pp.367~370 (1988)
- Bogduk N, "The nerve supply to the human lumbar intervertebral discs", J Anat, 132, pp.39~56 (1981)
- Singh V, "Percutaneous disc decompression using coblation(nucleoplasty)in the treatment of chronic discogenic pain", Pain Physician, 5, pp.250~259 (2002)
- Manchikanti L, "An update of the systematic assessment of mechanical lumbar disc decompression with nucleoplasty", Pain Physician, 16(2 Suppl), pp.SE25~SE54 (2013)
- Hirsch JA, "Automated percutaneous lumbar discectomy for the contained herniated lumbar disc : a systematic assessment of evidence", Pain Physician, 12, pp.601~620 (2009)
- Moon BJ, "Experimental evaluation of percutaneous lumbar laser disc decompression using a 1414 nm Nd : YAG laser", Pain Physician, 18, pp.E1091~E1099 (2015)