Korean J Pain.  2019 Apr;32(2):113-119. 10.3344/kjp.2019.32.2.113.

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

• Park CH
• Lee KK
• Lee SH

• KMID: 2449824
• DOI: http://doi.org/10.3344/kjp.2019.32.2.113

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.

Keyword

Annulus fibrosus; Case-control studies; Clinical trials; Disability evaluation; Intervertebral disc; Lasers; Low back pain; Pain management; Pain measurement; Radiofrequency ablation

MeSH Terms

Case-Control Studies
Catheter Ablation
Disability Evaluation
Humans
Intervertebral Disc
Low Back Pain*
Pain Management
Pain Measurement

Figure

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  Fig. 1 Oblique view of the 15-gauge spinal needle insertion. The needle was inserted at the identified entry point and directed lateral to the superior articular pillar toward the target lesion.

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  Fig. 2 Spinal needle placement in the anterior epidural space. (A) Anteroposterior and (B) lateral radiographic views.

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  Fig. 3 Forceps removal and laser ablation of interposed granulation or nucleus pulposus were performed through the annular puncture. (A) Anteroposterior and (B) lateral radiographic views.

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  Fig. 4 Representative discogram before intradiscal radiofrequency annuloplasty.

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  Fig. 5 (A) Granulation tissue was removed with small disc forceps and (B) ablated with the steerable radiofrequency Trigger-Flex® probe.

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