Thermal

Various radiofrequency procedures have been designed for the treatment of discogenic low back pain. The goal is to accurately place a radiofrequency device in the posterior annulus of the intervertebral disc where the painful nerve endings are located. Electrical energy is then used to ‘turn off’ the nerve endings, thus decreasing the sensation of pain from the disc.

Three technologies have undergone study and received attention over the last 15 years:

  • Intradiscal Thermal Annuloplasty (IDTA); better known as Intradiscal Electrothermal Therapy (IDET)
  • Posterior Radiofrequency Ablation (PRFA)
  • Biacuplasty (Transdiscal)

Unfortunately, when closely studied, the efficacy of these radiofrequency procedures has failed to fully meet expectations. Therefore, scientists have begun to search for an improved approach to radiofrequency lesioning of the posterior disc annulus. Recent attempts to fine-tune the biacuplasty procedure have been encouraging.

Biacuplasty (Transdiscal)

  • Biacuplasty (Transdiscal) is the most recently developed thermal technology in interventional spine pain management. Simply put, biacuplasty claims to be an easier, more reliable, minimally invasive approach for burning the nerve fibres in your painful disc.
  • Intradiscal Biacuplasty utilizes a bipolar system that includes two cooled, radiofrequency electrodes placed on the posterolateral sides of the outer ring of the disc (annulus fibrosus). Cooled radiofrequency may increase the lesion size and facilitate ablation (neurotomy of the nerve fibres in the back of the disc) compared to standard RF electrodes.
  • Biacuplasty is still in its early stages of clinical research. Early results are very encouraging. This procedure offers the advantage of being a much simpler operative technique than its predecessor, IDET.
Intradiscal Modulation

Fig 1. Illustration demonstrating a band of radiofrequency current between 2 Transdiscal probes. Fig. 2 Intra-operative x-ray of the final placement of two Transdiscal probes.

 

 

 

 

 

 

 

  • Inclusion Criteria:
    • Age ≥ 21
    • History of chronic low back pain (>6 months) unresponsive to non-operative care (including physical therapy, anti-inflammatory medication, epidurals, diagnostic facet joint/medial branch blocks, and sacroiliac joint interventions as performed or deemed appropappropriate by the Investigator)
    • Stabilized on pain medication regimen for >2 months as defined by a <10% change in dosage
    • Leg pain, if present, is not due to nerve compression.
    • Leg pain, if present, does not extend below the knee and is no greater than 50% of overall pain experience.
    • Single level concordant pain reproduction present on lumbar discography in desiccated disc. Magnetic resonance Imaging (MRI) image also supports discography findings. Changes in other disc spaces in the lumbar region do not demonstrate neural compressive lesion.
    • Minimal disc height loss -Disc height at least 50% of adjacent control disc.

Intradiscal Modulation in BC

  • Although both IDET and biacuplasty have been approved by Health Canada, neither is currently being performed in BC. The Royal College of Physicians and Surgeons of British Columbia is well aware of the potential benefits (demonstrated in early trials) of these procedures for patients with discogenic low back pain.
  • However, the College of B.C. has recommended waiting until further supportive studies have been performed, before offering such treatment to its residents. The Royal College of Physicians and Surgeons of BC considers the safety and well being of both its patients and physicians its top priority.
  • Recently a randomized double blind control trial demonstrated the efficacy of this procedure compared with placebo. The results were positive, but questions still remain. With the assistance of the Royal College, Dr. Helper will re-assess the role for biacuplasty in the treatment of British Columbia patients in 2015.
  • Currently, these procedures are being performed in the U.S. and in a few centres in Canada. In the meantime, Dr. Helper is performing the necessary diagnostic work-ups for patients with discogenic low back pain. If patients are found to meet the strict qualification criteria for Intradiscal Modulation, they will have the option of being referred to a qualified practitioner, who regularly performs the procedure. (Ontario, Quebec)