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Efficacy of transforaminal laser annuloplasty versus intradiscal radiofrequency annuloplasty for discogenic low back pain

  • Park, Chan Hong (Department of Anesthesiology and Pain Medicine, Daegu Wooridul Spine Hospital) ;
  • Lee, Kyoung Kyu (Department of Neurosurgery, Daegu Woridul Spine Hospital) ;
  • Lee, Sang Ho (Department of Neurosurgery, Chungdam Wooridul Spine Hospital)
  • 투고 : 2018.11.15
  • 심사 : 2019.01.15
  • 발행 : 2019.04.01

초록

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.

키워드

참고문헌

  1. Schwarzer AC, Aprill CN, Derby R, Fortin J, Kine G, Bogduk N. The prevalence and clinical features of internal disc disruption in patients with chronic low back pain. Spine (Phila Pa 1976) 1995; 20: 1878-83. https://doi.org/10.1097/00007632-199509000-00007
  2. Peng BG, Wu WW, Hou SX, Zhang CL, Yang Y, Wang XH, et al. The pathogenesis of discogenic low back pain. Chin J Surg 2004; 42: 720-4.
  3. Freemont AJ, Peacock TE, Goupille P, Hoyland JA, O'Brien J, Jayson MI. Nerve ingrowth into diseased intervertebral disc in chronic back pain. Lancet 1997; 350: 178-81. https://doi.org/10.1016/S0140-6736(97)02135-1
  4. Peng B, Wu W, Hou S, Li P, Zhang C, Yang Y. The pathogenesis of discogenic low back pain. J Bone Joint Surg Br 2005; 87: 62-7.
  5. Peng B, Hao J, Hou S, Wu W, Jiang D, Fu X, et al. Possible pathogenesis of painful intervertebral disc degeneration. Spine (Phila Pa 1976) 2006; 31: 560-6. https://doi.org/10.1097/01.brs.0000201324.45537.46
  6. Barendse GA, van Den Berg SG, Kessels AH, Weber WE, van Kleef M. Randomized controlled trial of percutaneous intradiscal radiofrequency thermocoagulation for chronic discogenic back pain: lack of effect from a 90-second 70 C lesion. Spine (Phila Pa 1976) 2001; 26: 287-92. https://doi.org/10.1097/00007632-200102010-00014
  7. Kapural L, Hayek S, Malak O, Arrigain S, Mekhail N. Intradiscal thermal annuloplasty versus intradiscal radiofrequency ablation for the treatment of discogenic pain: a prospective matched control trial. Pain Med 2005; 6: 425-31. https://doi.org/10.1111/j.1526-4637.2005.00073.x
  8. Oh WS, Shim JC. A randomized controlled trial of radiofrequency denervation of the ramus communicans nerve for chronic discogenic low back pain. Clin J Pain 2004; 20: 55-60. https://doi.org/10.1097/00002508-200401000-00011
  9. Nachemson A, Zdeblick TA, O'Brien JP. Lumbar disc disease with discogenic pain. What surgical treatment is most effective? Spine (Phila Pa 1976) 1996; 21: 1835-8. https://doi.org/10.1097/00007632-199608010-00023
  10. Zhou Y, Abdi S. Diagnosis and minimally invasive treatment of lumbar discogenic pain--a review of the literature. Clin J Pain 2006; 22: 468-81. https://doi.org/10.1097/01.ajp.0000208244.33498.05
  11. Khot A, Bowditch M, Powell J, Sharp D. The use of intradiscal steroid therapy for lumbar spinal discogenic pain: a randomized controlled trial. Spine (Phila Pa 1976) 2004; 29: 833-6. https://doi.org/10.1097/00007632-200404150-00002
  12. Lee JH, Lee SH. 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 2017; 105: 832-40. https://doi.org/10.1016/j.wneu.2017.06.112
  13. Lee JH, Lee SH. Clinical efficacy of percutaneous endoscopic lumbar annuloplasty and nucleoplasty for treatment of patients with discogenic low back pain. Pain Med 2016; 17: 650-7. https://doi.org/10.1093/pm/pnv120
  14. Lee SH, Kang HS. Percutaneous endoscopic laser annuloplasty for discogenic low back pain. World Neurosurg 2010; 73: 198-206. https://doi.org/10.1016/j.surneu.2009.01.023
  15. Kumar N, Kumar A, Siddharth MS, Sambhav PS, Tan J. Annulo-nucleoplasty using Disc-FX in the management of lumbar disc pathology: early results. Int J Spine Surg 2014; 8: 18. https://doi.org/10.14444/1018
  16. 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 2014; 8: 24. https://doi.org/10.14444/1024
  17. Lee SH, Lee SH, Lim KT. Trans-sacral epiduroscopic laser decompression for symptomatic lumbar disc herniation: a preliminary case series. Photomed Laser Surg 2016; 34: 121-9. https://doi.org/10.1089/pho.2015.4000
  18. Cheng J, Zheng W, Wang H, Li C, Wang J, Zhang Z, et al. Posterolateral transforaminal selective endoscopic diskectomy with thermal annuloplasty for discogenic low back pain: a prospective observational study. Spine (Phila Pa 1976) 2014; 39(26 Spec No.): B60-5. https://doi.org/10.1097/BRS.0000000000000495
  19. Derby R, Eek B, Chen Y, O'neill C, Ryan D. Intradiscal Electrothermal Annuloplasty (IDET): a novel approach for treating chronic discogenic back pain. Neuromodulation 2000; 3: 82-8. https://doi.org/10.1046/j.1525-1403.2000.00082.x
  20. Yu SW, Sether LA, Ho PS, Wagner M, Haughton VM. Tears of the anulus fibrosus: correlation between MR and pathologic findings in cadavers. AJNR Am J Neuroradiol 1988; 9: 367-70.
  21. Bogduk N, Tynan W, Wilson AS. The nerve supply to the human lumbar intervertebral discs. J Anat 1981; 132: 39-56.
  22. Singh V, Piryani C, Liao K, Nieschulz S. Percutaneous disc decompression using coblation (nucleoplasty) in the treatment of chronic discogenic pain. Pain Physician 2002; 5: 250-9.
  23. Manchikanti L, Falco FJ, Benyamin RM, Caraway DL, Deer TR, Singh V, et al. An update of the systematic assessment of mechanical lumbar disc decompression with nucleoplasty. Pain Physician 2013; 16(2 Suppl): SE25-54.
  24. Hirsch JA, Singh V, Falco FJ, Benyamin RM, Manchikanti L. Automated percutaneous lumbar discectomy for the contained herniated lumbar disc: a systematic assessment of evidence. Pain Physician 2009; 12: 601-20.
  25. Moon BJ, Lee HY, Kim KN, Yi S, Ha Y, Yoon DH, et al. Experimental evaluation of percutaneous lumbar laser disc decompression using a 1414 nm Nd:YAG laser. Pain Physician 2015; 18: E1091-9.

피인용 문헌

  1. Questions and comments on the efficacy of transforaminal laser annuloplasty versus intradiscal radiofrequency annuloplasty for discogenic low back pain vol.32, pp.4, 2019, https://doi.org/10.3344/kjp.2019.32.4.313
  2. Author's reply vol.32, pp.4, 2019, https://doi.org/10.3344/kjp.2019.32.4.314
  3. Transforaminal Epiduroscopic Laser Ablation for Removal of a Postlaminectomy Synovial Cyst: A Case Report vol.56, pp.5, 2019, https://doi.org/10.3390/medicina56050209