To investigate the efficacy and safety of percutaneous intradiscal monopolar pulsed radiofrequency (PRF) in patients with chronic disabling discogenic back pain.
Twenty-six subjects (7 males; mean age 43.2 years) with chronic back pain refractory to active rehabilitative management were recruited. All subjects underwent MRI for evaluation of Modic changes, and monopolar PRF (20 min at 60 V) at the center of target lumbar intervertebral disc confirmed by pressure-controlled provocative discography. Clinical outcomes were measured by the visual analogue scale (VAS), Oswestry disability index (ODI), and sitting tolerance time (ST) for 12 months after treatment. Successful clinical outcome was described as a minimum of 2 point reduction in VAS compared with the baseline at each follow-up period.
The mean VAS for low back pain reduced significantly from 6.4±1.1 at pre-treatment to 4.4±1.9 at 12 months (p<0.05). The mean ODI score was 47.3±15.4 points at pre-treatment and 36.7±19.5 at 12 months (p<0.001). The ST was 27.8±20.4 minutes at pre-treatment and 71.5±42.2 at 12 months (p<0.001). However, successful clinical outcome was achieved at 58%, 50%, and 42%, measured at 3, 6, and 12 months post-treatment. There were no significant relationship between the clinical outcome and Modic changes; no adverse events were recorded.
The results demonstrated that the application of intradiscal monopolar PRF might be relatively effective but limited; successful intervention for chronic refractory discogenic back pain is needed. To achieve the optimal outcome through intradiscal PRF, we suggested further studies about stimulation duration, mode, and intensity of PRF.
Citations
Objective: To observe histological changes of the intervertebral disc injected with intradiscal steroid and mollification of discogenic pain.
Method: A study group of 25 Sprague-Dawely rats was divided into five subgroups. A control group of 10 Sprague-Dawely rats was divided into five subgroups. The rats' intervertebral discs were exposed by an anterior surgical approach. For study group, the rats were injected intradiscally methylprednisolone acetate 4 mg (Depomedrol, 40 mg/ml) to the L4-L5 intervertebral disc, methylprednisolone sodium succinate 4 mg (Solumedrol, 40 mg/ml) to the L5-L6 intervertebral disc, and triamcinolone acetonide 4 mg (Triamcinolone, 40 mg/ml) to the L6-S1 intervertebral disc. For control group, the rats were injected intradiscally 0.1 ml of saline to the L5-L6 intervertebral disc and a needle was inserted in the L6-S1 intervertebral disc. The intervertebral discs were extracted after 1 week, 2 weeks, 3 weeks, 4 weeks, and 16 weeks. The extracted intervertebral discs were stained with Hematoxylin-Eosin and examined histomorphometrically.
Results: There is no significant histological change in either group until 4 weeks after the different types of steroid were injected. Focal fibrotic change was present in the Solumedrol and Triamcinolone injection subgroups after 16 weeks.
Conclusion: We concluded that rapid mollification of discogenic pain following intradiscal steroid injection may not result from histological change of the disc. Further biochemical study will be neccessary to clarify mollification mechanism of discogenic pain by intradiscal steroid injection.
Objective: To determine the relationship between magnetic resonance imaging (MRI) and discography in visualization of disc degeneration.
Method: Forty-eight patients with suspected discogenic pain in lumbar spines and degenerative changes of the lumbar intervertebral discs in T2-weighted magnetic resonance imaging were studied. Five types of discogram (cottonball, lobular, irregular, fissured, and ruptured) were classified by identifiable features in shape and density of radio-opaque shadow. Three types of MRI (bulging, protrusion, and extrusion) were classified by degrees of disc herniation. The correlation between two imaging techniques of lumbar intervertebral discs were analyzed using Spearman's correlation coefficient.
Results: Of sixty-three discs, MRI finding of the disc herniation revealed as follows: bulging, 17 discs; protrusion, 20 discs; extrusion, 26 discs. Discography revealed as follows: cottonball, 15 discs; lobular, 2 discs; irregular, 11 discs; fissured, 10 discs; ruptured, 25 discs. 46 discs of 63 discs showed internal structural abnormalities (irregular, fissured, or ruptured). There was no statistically significant correlation between MRI and discography in visualization of the disc degeneration (r=0.081).
Conclusion: Severity of the lumbar intervertebral disc degeneration in MRI was not correlated with degenerative severity of discographic imaging. Supplementary discography may be useful in evaluation of patients with discogenic pain since discographic imaging when compared to MRI visualizes disc degeneration more accurately.
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