Long-lasting improvements for discogenic low-back pain treated with minimally invasive intradiscal biacuplasty

Interest in the use of IDB is growing in connection with the need for less invasive treatment options to treat discogenic low-back pain, study authors said. The treatment involves placing 2 cooled radiofrequency (RF) electrodes in affected discs to ablate the nerve fibers of the intervertebral disc cover, thus interrupting the generation of pain sensations.

Appropriate candidate selection is considered key to a good patient outcome in IDB.

"This minimally invasive procedure should be limited to younger patients with discogenic pain arising only from 1 or 2 lumbar discs and without other sources of lower back pain," said lead study author Leonardo Kapural, MD, PhD, of the Carolinas Pain Institute and Center for Clinical Research in Winston-Salem, N.C. Dr. Kapural led a collaborative research team from the North Carolina facility and the Cleveland Clinic in Cleveland, Ohio.

The current study is a follow-up to a 6-month, double-blind, sham, randomized study (Kapural L et al, Pain Med 2013;14(3):362-73). After unblinding, investigators continued to follow 22 out of 27 subjects in the original active treatment group for 12 months. Patients reported outcomes on physical function, pain and disability via the SF-36 health survey, the 11-point pain numerical rating scale (NRS) and the Oswestry low-back pain disability questionnaire.

Clinically significant improvements reported at 6 months in the original treatment arm were maintained at 9 and 12 months for physical function (∆ = 22) and pain (∆=-2.9).

Moreover, crossover patients who had been randomized to sham therapy during the initial study reported improvements after IDB that did not differ statistically from those of patients originally randomized to IDB treatment. Of 30 patients in the original sham group, 24 chose to crossover to IDB treatment, and 20 completed follow up.

Discogenic pain, which occurs when the intervertebral discs degenerate or wear out, is the most common cause of chronic low-back pain. The majority of sufferers have multilevel disease and would not be candidates for IDB, Dr. Kapural emphasized. Current surgical treatment options are limited to fusion and disc arthroplasty and have been suggested to yield very low success rates, he said.