Intradiscal electrothermal therapy (IDET): a viable alternative to surgery for low back pain in workers' compensation patients?

OBJECTIVE: This prospective study was conducted to evaluate improvements in pain and disability in a series of 53 consecutive worker's compensation patients with discogenic low back pain following treatment with the intradiscal electrothermal therapy (IDET) procedure. MATERIAL AND METHODS: Between 2002 and 2004, a total of 53 consecutive patients, who were claimants of worker's compensation, were treated using IDET for their discogenic low back pain. The outcomes of these patients were analyzed statistically for the current study by physical exam and self-assessment questionnaires of pain and disability at baseline and at 24-months post-procedure. Pain and disability outcomes were assessed by visual analog pain score (VAS) on a 0-100 mm scale and Oswestry Disability Index respectively. RESULTS: The mean patient age was 41.83 years (range 20 to 61 years). Caucasians (53 %), African-Americans (30%), and Hispanics (17%) formed the majority of population. Forty-nine percent were using narcotic pain medications at the time of initial assessment. The first definitive end point was considered at 24 months after the procedure. Median follow-up period was 56 months (range 29-72 months). A mean reduction (p < 0.001) of 63% in the VAS score and 70% in the Oswestry scores was noted after IDET. The patient's initial VAS and Oswestry scores (p < 0.05) significantly affected the final outcomes. Forty-seven percent of the patients returned to some degree of economic productivity and only seven (initial 26) consumed narcotic analgesics. CONCLUSION: IDET procedure can be a useful, safe and cost-effective option in the management of carefully selected workers' compensation claimants with chronic low back pain of discogenic etiology.

Choice of plate may affect outcomes for single versus multilevel ACDF: results of a prospective randomized single-blind trial.

BACKGROUND CONTEXT: Conflicting views exist according to the individual philosophy about various plate designs that can be used in anterior cervical discectomy and fusion (ACDF) to achieve clinical and radiological improvement within shortest time period. No prospective randomized study has ever been conducted to clarify the relationship between clinical outcomes, fusion rates, and the choice of plate (static vs. dynamic design). PURPOSE: To compare the clinical and radiological outcomes of patients treated with one-level or multiple levels ACDF using cervical plates of dynamic (slotted-holes) versus static (fixed-holes) design. STUDY DESIGN: Single masked, prospective, randomized study. PATIENT SAMPLE: Over a 4-year period, 66 patients (M:F=37:29) had ACDF using either dynamic (n=33) or static (n=33) plates for intractable radiculopathy as the result of degenerative cervical spine disease. Overall, 28 patients had single-level fusion and 38 had two or three levels fused. OUTCOME MEASURES: Visual Analogue Pain scores (VASs), Neck Disability Index (NDI), and radiological criteria of established fusion. METHODS: The qualifying subjects were randomized to receive ACDF using either fixed-holes (static) or the slotted-holes (dynamic) anterior cervical plates. Clinical and radiographic data were collected and analyzed. Paired-sample t test was used to correlate clinical and radiological outcomes and General Linear Model Analysis of Variance (GLM ANOVA) with repeated measures was used to detect outcome differences between the two groups for single and multiple fusions. RESULTS: At a mean follow-up of 16 months (range, 12-24), 49 patients (73.7%) had clinical success and 56 (85%) showed radiological fusion. Although clinical success was a predictor of fusion (p=.043), the reverse was not true (p=.61). In single-level fusion, no statistical difference of outcome was observed between the two groups but multilevel fusions with dynamic plate showed significantly lower VAS and NDI than those with static plates (p=.050). CONCLUSIONS: Although clinical improvement is a good predictor of successful ACDF, radiological evidence of fusion alone is not reliable as a parameter of success. The design of plate does not affect the outcomes in single-level fusions but statistics indicate that multiple-level fusions may have better clinical outcome when a dynamic plate design is used.

Intradiscal electrothermal therapy (IDET) for low back pain in worker's compensation patients: can it provide a potential answer? Long-term results.

OBJECTIVE: This prospective study was conducted to evaluate improvements in pain and disability in a series of 53 consecutive worker's compensation patients with low back pain (LBP) after treatment with the intradiscal electrothermal therapy (IDET) procedure. MATERIALS AND METHODS: All patients seen in the out-patient clinic of the Spine Institute of Louisiana for LBP of discogenic origin were screened for eligibility to receive IDET procedure. A total of 134 patients were treated using IDET for their discogenic LBP during the study period. Fifty-three patients presented to us via the worker's compensation claim program. The outcomes of these 53 patients were analyzed statistically for the current study by physical examination and self-assessment questionnaires of pain and disability at baseline and at 12-months postprocedure. Pain and disability outcomes were assessed by visual analog scale (VAS) pain score and Oswestry disability index, respectively. RESULTS: The mean patient age was 41.83 years (range 20 to 61 y). Whites (52.8%), African-Americans (30.2%), and Hispanics (17%) formed the majority of population. Forty-nine percent were using narcotics. The first definitive end point was considered at 12 months after the procedure. Median follow-up period was 56 months (range 29 to 72 mo). A mean reduction (P<0.001) of 62.6% in the VAS score and 69.3% in the Oswestry scores was noted after IDET. The patient's initial VAS and Oswestry scores (P<0.05) significantly affected the final outcomes. About 47.2% of the patients had some degree of economic productivity and only 7 (initial 26) consumed narcotic analgesics. CONCLUSIONS: IDET procedure can be a useful, safe, and cost-effective option in the management of carefully selected workers compensation claimants with chronic LBP of discogenic etiology.