Ann Rehabil Med.  2012 Oct;36(5):648-656.

Effect of Intradiscal Monopolar Pulsed Radiofrequency on Chronic Discogenic Back Pain Diagnosed by Pressure-Controlled Provocative Discography: A One Year Prospective Study

• Jung YJ
• Lee DG
• Cho YW
• Ahn SH

Abstract

OBJECTIVE
To investigate the efficacy and safety of percutaneous intradiscal monopolar pulsed radiofrequency (PRF) in patients with chronic disabling discogenic back pain. METHOD: 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.
RESULTS
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.
CONCLUSION
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.

Keyword

Pulsed radiofrequency; Discogenic pain; Intradiscal procedure

MeSH Terms

Back Pain
Follow-Up Studies
Humans
Intervertebral Disc
Low Back Pain
Prospective Studies

Figure

• 

  Fig. 1 The mean visual analogue scale (VAS) of patients for lower back pain was 6.4±1.1, prior to the intradiscal pulsed radiofrequency (PRF) treatment, 4.1±1.8 at 1 month, 4.1±1.9 at 3 months, 4.2±2.0 at 6 months, and 4.4±1.9 at 12 months after treatment. The magnitude of change was relatively small. The data were expressed as the mean VAS ± standard error. PRE: Pretreatment of PRF. *p<0.01 compared to the pretreatment of PRF.

• 

  Fig. 2 The mean Oswestry disability index (ODI) score was 47.3±15.4 points before the intradiscal pulsed radiofrequency (PRF) treatment, 33.7±18.3, 32.4±18.5, 34.0±18.1, and 36.7±19.5 points at 1, 3, 6, and 12 months after treatment, respectively. The magnitude of change was relatively small. The data were expressed as the mean ODI±standard error. PRE: Pretreatment of PRF. *p<0.05 compared to the pretreatment of intradiscal PRF.

• 

  Fig. 3 The mean sitting tolerance time (ST) was 27.8±20.4 minutes at pretreatment of the intradiscal pulsed radiofrequency (PRF), 70.8±43.2 at 1 month, 78.5±42.2 at 3 months, 71.5±42.2 at 6 months, and 71.5±42.2 at 12 months after treatment, respectively. The data were expressed as the mean ST±standard error. PRE: Pretreatment of PRF. *p<0.05 compared to the pretreatment of intradiscal PRF.

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