Paper
Lumbar Intradiscal Treatment: A Comparison between 5 Modalities (Physiotherapy/Chiropractic, IDET, Decompressor, Nucleoplasty, Disk-Fx) in 592 Cases in a Single Surgeon's Practice
Published Jun 1, 2012 · H. Singh
Global Spine Journal
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Abstract
Introduction There are many methods of intradiscal treatments for degenerative disk disease. However, there are no reports of direct comparison of efficacy and patient satisfaction between the five modalities of the following: Physiotherapy/Chiropractic treatment IDET™ (Smith and Nephew) Dekompressor™ (Stryker) Nucleoplasty™ (Arthrocare), Disc-Fx™ (Ellman) Materials and Methods Total 70 patients with clinically significant lumbar disk disease as defined by back pain with or without leg pain, with an MRI proven disk lesions (disk bulges or contained herniations), were treated by physiotherapy/chiropractic modalities between January 2005 to December 2006 (24 months). Mean follow-up was 28.5 months. Mean follow-up was 24.33 months (14 months - 52 months). VAS and ODI were assessed preprocedure and at 3 months postintervention. Total 55 patients with clinically significant lumbar disk disease as defined by back pain with or without leg pain, with an MRI proven disk lesions (disk bulges or contained herniations), were treated by IDET between January 2005 to December 2006 (24 months). Mean follow-up was 28.5 months. Mean follow-up was 24.33 months (14 months to 52 months). VAS and ODI were assessed preprocedure and at 3 months postintervention. Total 165 patients with clinically significant lumbar disk disease as defined by back pain with or without leg pain, with an MRI proven disk lesions (disk bulges or contained herniations), were treated by mechanical decompression (Stryker) between January 2005–December 2006 (24 months). Mean follow-up was 24.33 months (14 months to 52 months). VAS and ODI were assessed preprocedure and at 3 months postintervention. Total 166 patients with clinically significant lumbar disk disease as defined by back pain with or without leg pain, with an MRI proven disk lesions (disk bulges or contained herniations), were treated by RF ablation (ArthroCare) between August 2007 to December 2011 (52 months). Mean follow-up was 24.87 months (9 months to 36 months). VAS and ODI were assessed preprocedure and at 3 months postintervention. Total 136 patients with clinically significant lumbar disk disease as defined by back pain with or without leg pain, with an MRI proven disk lesions (disk bulges or contained herniations), were treated by endoscopic-assisted RF ablation (Ellman) between October 2009–June 2011 (21 months). Mean follow-up was 12.33 months (3 months to 21 months). VAS and ODI were assessed preprocedure and at 3 months postintervention. Results VAS 8.5 to 4.0; ODI 25.1 to 11.0 (p < 0.0001) VAS 8.3 to 3.2; ODI 25.2 to 10.2 (p < 0.0001) VAS 8.3 to 3.2; ODI 25.1 to 10.0 (p < 0.0001) VAS 7.4 to 4.0; ODI 21.8 to 9.8 (p < 0.0001) VAS 7.3 to 4.0; ODI 22.7 to 10.2 (p < 0.001) Physiotherapy/Chiropractic VAS Reduction ODI Reduction 4.5 14.1 ODI, Oswestry disability index; VAS, visual analogue scale. IDET VAS reduction ODI reduction 5.1 15.0 Decompressor VAS reduction ODI reduction 5.1 15.1 Nucleoplasty VAS reduction ODI reduction 3.4 12.0 Disk-Fx VAS reduction ODI reduction 3.3 12.5 Conclusion In this single surgeon series, a direct controlled comparison of all five modalities can be made. Intervention in all modalities did give statistically significant symptom relief. When modalities are evaluated, some trends are noted, though not statistically significant. It appears that Stryker and IDET had the best patient satisfaction (VAS difference 5.1, ODI difference 15.1), followed by RF ablation (nucleoplasty and Disk Fx) (VAS difference 3.4, ODI difference 12.0). Interestingly, physiotherapy/chiropractic treatments had good patient satisfaction comparable to intervention. This investigator concludes that the criteria for a good intradiscal treatment outcome is depended on smaller annular puncture, and less RF (burning) of the nucleus. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared H Singh. Altering the natural history of lumbar disk disease. Do mechanical intradiscal therapies work? A preliminary report with an evaluation of patient satisfaction. 27th ISMISS/PESS, Zurich, 2009 H Singh. Intradiscal therapies: Is there any difference between methods/modalities. 28th ISMISS/PESS, Zurich 2010 H Singh. Intradiscal treatments: Is there any difference between mechanical decompression and RF ablation of nucleus pulposus (needle and endoscopic assisted). 30th ISMISS/PESS, Zurich 2012 (accepted)
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