Posterior Position of Disc Decompression Device Tip is correlated with Better Treatment Outcome in Discogenic Low Back Pain

Abstract

Objective: The outer portion of Discogenic low back pain is mostly contributable to the abundantly innervated outer annulus. Conventional electrothermal device can not provide sufficient temperature to the outer annulus. The aim of this study is evaluate the correlation between the tip position of the navigable percutaneous disc ablation device named L'DISQ and the treatment outcome during intervertebral disc ablation procedure.

Method: Participants consisted of 13 discogenic low back pain patients. Inclusion criteria were symptomatic duration more than 3 months, unresponsiveness to the oral analgesics, physical modalities and spinal interventions, only one level of symptomatic disc with concordant pain resulted from provocation discography, and agreement to the L'DISQ procedure. Patients with radicular pain or zygoapophyseal joint symptom were excluded. During the procedure most posteriorly approached position of the tip of ablating wand is recorded. We evaluate the correlation between the tip position and the treatment outcome.

Result: Correlation between the proximity of the wand to the posterior margin of the intervertebral disc and therapeutic outcomes were significant . The correlation coefficient between the distance ratio and improvement of patients'VAS index was 0.6. Cases in which the ablation tip was contained only in the nucleus showed poor treatment outcome.

Conclusion: Discogenic low back pain is thought to be related primarily with outer annulus region of intervertebral disc which has relatively abundant nociceptive nerve endings. During the electrothermal disc decompression procedure as the ablation wand approached more posterior region of the annulus, we could find more preferable clinical outcome of the patients.