Efficacy of IDET and PIRFT for the Treatment of Discogenic Low Back Pain

Chapter

Abstract

Percutaneous intradiscal thermocoagulation techniques were introduced in 2000 as a minimally invasive treatment option for patients with discogenic low back pain (LBP). Controlled thermal energy is delivered to the intervertebral disc via a percutaneous intradiscal catheter inserted under radiological guidance. There are two different techniques depending on whether the heat is generated by radiofrequency (Percutaneous Intradiscal Radio-Frequency Thermocoagulation [PIRFT]) or by a thermal resistive coil (Intra-Discal Electrothermal Therapy [IDET]). Early studies of IDET were promising with reduction of pain and functional improvements reported by the originators of the technique. There followed a number of positive reports derived from data registers. These studies, however, do not take into account the natural history of LBP, the placebo response or other potential confounders. Bogduk and Karasek [15] suggested that IDET improved a higher proportion of patients than a rehabilitation programme. All patients included in this study requested IDET. The “control” group was composed of patients for whom the procedure was denied by their insurance company and who were pursuing litigation to have the IDET procedure. Two randomized controlled trials (RCTs) were later performed leading to contradictory results. Pauza et al. [16] randomized 64 patients (37 to IDET and 27 to Sham) and suggested that IDET is slightly better than placebo for pain and disability, although the size of this effect is clinically insignificant. Freeman et al. [17] randomized 57 subjects (38 to IDET and 19 to Placebo) and showed no significant benefit from IDET over placebo. The available evidence does not support the effectiveness of PIRFT or IDET. Despite this, more than 75,000 IDET procedures have been performed in the USA alone since 1998. For ethical, clinical and legal reasons, this behaviour appears inappropriate. Clinicians treating patients with LBP should refrain from using new technologies based on promising results derived from case reports or non-randomized trials.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2010

Authors and Affiliations

  1. 1.Department of Spinal Surgery, Level 3, Theatre BlockRoyal Adelaide HospitalAdelaideAustralia

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