biacuplasty

[Harrison]

Sue, here's a few abstracts you may have seen...

Intradiscal electrothermal therapy (IDET) provides effective symptom relief in patients with discogenic low back pain.
Maurer P, Block JE, Squillante D. 3B Orthopaedics, Pennsylvania Hospital, University of Pennsylvania Health System, 800 Spruce Street, 8th Floor, Philadelphia, PA, USA.

STUDY DESIGN: Single-arm, prospective clinical trial.

OBJECTIVE: To evaluate back pain severity, physical function, and quality of life outcomes in highly selected patients with lumbar discogenic pain treated with intradiscal electrothermal therapy (IDET).

SUMMARY OF BACKGROUND DATA: Degeneration and disruption of the intervertebral disc can be the source of severe low back pain and the associated physical dysfunction. IDET is a minimally invasive treatment option in the continuum of care between conservative nonoperative management and spinal surgery.

METHODS: Using magnetic resonance imaging, pressure-controlled discography, and postdiscogram computed tomography findings, 56 patients with lumbar discogenic pain were identified, underwent IDET treatment and followed for 20.5+/-4.4 months, on average. Outcomes included assessments of back pain severity by visual analog scale, sitting, standing, and walking tolerances, and health-related quality of life using the SF-36.

RESULTS: Mean pain severity scores (visual analog scale) improved from 6.1+/-1.8 pretreatment to 2.4+/-2.6 at final follow-up (P=0.0001). Mean tolerance times (minutes) improved from 40.9+/-40.6 to 84.5+/-54.4, 46.8+/-42.9 to 84.4+/-54.2, and 39.2+/-39.6 to 77.9+/-50.8 between baseline and final follow-up for sitting, standing, and walking, respectively (P=0.0001 for all comparisons). Seven of 8 quality of life domains showed significant (P=0.0001 for all comparisons) improvement over baseline. Forty-two patients (75%) were classified as a treatment success by virtue of a >or=2-point improvement in pain severity or a >or=10-point improvement in either the physical functioning or bodily pain domain of the SF-36.

CONCLUSIONS: The findings of this study suggest that durable clinical improvements can be realized after IDET in highly selected patients with mild disc degeneration, confirmatory imaging evidence of annular disruption, and concordant pain provocation by low pressure discography.
__________________________________________________ ____________________________________

Novel intradiscal biacuplasty (IDB) for the treatment of lumbar discogenic pain.

Kapural L, Mekhail N. Department of Pain Management, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. Kapural (at) ccf.org

Reported here is the treatment of severe axial discogenic pain in a young man utilizing the new minimally invasive transdiscal radiofrequency technique called intradiscal biacuplasty (Baylis Medical Inc., Montreal, Canada).

The new procedure is detailed and step-by-step fluoroscopic imaging presented. There were no intra- and postoperative complications, and significant improvements in patient functional capacity, and pain scores were noted. Visual analog scale pain score decreased from 5 to 1 cm at 6-month follow-up, Oswestry disability scores improved from 14 (28% or moderate disability) to 6 points (12% or minimal disability) and SF-36-PF (physical function) score changed from 67 to 82. Potential advantages of cooled, bipolar radiofrequency to heat the posterior annulus are discussed.

[ERvet]

[quote=Eddie_G;79567]If there is the SLIGHTEST chance that the insurance co. would pay I would not give up.
An insurance company employee's job is to save money and deny deny deny until us victims give up. quote]


Eddie: not planning on giving up....I dropped the ADR request because I really wasn't ready to go through another surgery. But THIS, this I'm going to fight for. I guess I need a denial before I get all postal on them, eh? But I have a can of wupa$$ I am planning on opening.....
Enjoying some VERY un-November-like weather here in sunny Colorado. Not so great for the skiers, but that ain't me!

Susan/ERvet

[ERvet]

Harrison: I have the second one, haven't seen the first one (what was the year on that one?), and found a couple others (I think the titles I mentioned a couple posts back) that I would like to read, but our local univ library can't provide the full text on-line due to publisher limitations. I need to actually GO to the library (which is SO 90's) and find the actual journal. Which I plan on doing just to get the info. Or I might pop on over to our local hospital library and look up past issues. It seems many of them are in the journal Pain Medicine. And most of the biacuplasty articles are in this year's issues.

Susan

[CharlesinCharge]

Susan and Harrison,

My Pain Management doctor told me that IDET fell out of favor because it was really just intended for very specific, limited use---patients with small, contained tears in the annulus of the disc. It actually worked pretty well on those patients (and still does), but then they started using it on anyone who had DDD. Most of us with DDD have so much damage in the disc (not just a small tear) that IDET was useless.

IDET used a heated probe, which caused the annulus of the disc (which is primarily made of collagen) to shrink and contract, supposedly sealing the tears. But, it was hard to control and often the heat did more damage than good. Biaculaplasty used Radio Frequency to destroy the nerve endings inside the disc, much like a Rhizotomy on the facet joints. I was told it was much more sophisticated and effective than IDET, but again only about a 50% chance for true success and most insurance companies won't pay for such a new, unproven technique.