Upcoming biacuplasty

[laid up doc]

Finally got it scheduled for next week... I know the slant here is a little more pro-surgery, but for those of you who are, like me, trying to put off surgery as long as possible... I will update you all how it goes. Doesn't seem like anyone here has had it done, so hopefully those looking in the future can learn something.

For those not familiar w/ the procedure, it's somewhat similar to IDET but is more precise and use radiofrequency rather than thermal heat. End result/goals are fairly similar to IDET - heal annular tear and "burn off" nerves supplying the disc. It's a new procedure and not many docs are doing it yet. There is about to be a multicenter clinical trial started - I believe one of the sites is George Washington in DC as that is where my doc also sees pts. I can ask my doc who the sponsoring company is, I know Baylis makes one device but I believe he said Kimberly-Clark was the company sending my probes...?

See my signature - I have 1 level symptomatic disc dz w/ concordant discogram, no other spine issues per imaging or history. Not doing well this last week or so... just trying to hang in there physically and mentally til then!

I was not able to get Aetna PPO to cover it (will still be "investigational" until RCT's are done showing benefit), but they do apparently cover up to $500 of non-covered expenses under a certain code. I only got this info b/c I asked. I have been able to bring the cost way down due to the work of my pain dr to get the equipment free from the manufacturer, his generosity in not charging me for time, and my hospital giving me a big discount. For full disclosure - I am a physician at this hospital - or was until this back problem forced me out on medical leave.

[Harrison]

Hey "LUD,"

Thanks for sharing this information. Do you happen to know more about the technology that may be used for your procedure? I understand that the newer generations are considerably more effective (or are said to be) than previous technology & procedures. Also, I thought some new ones do not generate excessive heat -- which can be a problem? Any way, I wish that the research articles were more specific...see the below article which you probably already read.

And you are right about the prevailing "culture" of the community: many folks have suffered with severe pain for years and suffer from "just-fix-me-itis." It is sad, but I've been there and I know the feeling! Because of a successful procedure, and subsequent natural therapies, I am 100% pain-free.

My long term efforts (as noted on the non-profit home page) are devoted to ALL aspects of preserving healthy motion in the spine. I hope that in time, our efforts help patients avoid degeneration of their entire bodies. I believe that drastic changes in diet and lifestyle can help all of us get back on track!

Any way, I digress. Back to you.

_________________________________

Intervertebral Disc Biacuplasty for the Treatment of Lumbar Discogenic Pain:
Results of a Six-Month Follow-Up

1. Leonardo Kapural MD, PhD1,*,
2. Alan Ng MD1,
3. Jarrod Dalton MA2,
4. Edward Mascha PhD2,
5. Miranda Kapural MD1,
6. Miguel de La Garza MD1,
7. Nagy Mekhail MD, PhD1

Article first published online: 31 JAN 2008

Objective.  Intradiscal biacuplasty (IDB) is a novel bipolar cooled radiofrequency system for the treatment of degenerative disk disease. We present the results of a pilot trial with 6-month follow-up.

Design, Setting, Patients, and Interventions.  Fifteen patients, 22–55 years old, underwent one- or two-level IDB treatment of their painful lumbar discs. All had chronic low back pain >6 months, back pain exceeding leg pain, concordant pain on provocative discography, disc height >50% of control, and evidence of single- or two-level degenerative disc disease without evidence of additional changes on magnetic resonance imaging. IDB was performed under fluoroscopy using two radiofrequency probes positioned bilaterally in the intervertebral disc. Thirteen patients completed follow-up questionnaires at 1, 3, and 6 months. Pain disability was evaluated with Oswestry and Short Form (SF)-36 questionnaires.

Results.  Median visual analog scale pain scores were reduced from 7 (95% confidence interval [CI] 6, 8) to 4 (2, 5) cm at 1 month, and remained at 3 (2, 5) cm at 6 months. The Oswestry improved from 23.3 (SD 7.0) to 16.5 (6.8) points at 1 month and remained similar after 6 months. The SF-36 Physical Functioning scores improved from 51 (18) to 70 (16) points after 6 months, while the SF-36 Bodily Pain score improved from 38 (15) to 54 (23) points. Daily opioid use did not change significantly from baseline: from 40 (95% CI 40, 120) before IDB to 5 (0, 40) mg of morphine sulfate equivalent 6 months after IDB. No procedure-related complications were detected.

Conclusions.  Patients showed improvements in several pain assessment measures after undergoing IDB for discogenic pain. A randomized controlled study is warranted and needed to address the efficacy of the procedure

[laid up doc]

Harrison,

Yes the heat is more evenly distributed than w/ IDET... I just learned that Dr Kapural (author of that study and inventor of the procedure) is leaving Cleveland Clinic and going to my med school to improve their spine pain program. Too bad I don't live there... but my doc here is awesome nonetheless!

I'm hoping to avoid surgery or put it off for some years... my goal is to get better enough after the biacuplasty to be more active, get off some excess weight, and prevent further issues. I'm going to have to change my practice environment significantly if not leave clinical medicine altogether. Hard to help others when you're struggling to care for yourself - often said but I didn't heed that well enough soon enough! Now I have no viable option...

If I have no other option I will consider ADR/fusion, but I'm very very reluctant to have such an invasive procedure when I am quoted 60-70% efficacy for relief of back pain... especially at the relatively young age of 32! Maybe if some of the lateral approaches are improved on I'd feel better about it, but having an anterior surgery is scary to me. I know too much about medicine and complications!! Part of my strategy is that I want to let surgical techniques and materials improve as much as possible prior to surgery. I understand that not everyone is in my shoes and you sure can't apply one person's situation to another - another reason it's hard to predict surgical outcomes.

[silversurfer]

Originally Posted by laid up doc

If I have no other option I will consider ADR/fusion, but I'm very very reluctant to have such an invasive procedure when I am quoted 60-70% efficacy for relief of back pain... especially at the relatively young age of 32! Maybe if some of the lateral approaches are improved on I'd feel better about it, but having an anterior surgery is scary to me. I know too much about medicine and complications!! Part of my strategy is that I want to let surgical techniques and materials improve as much as possible prior to surgery. I understand that not everyone is in my shoes and you sure can't apply one person's situation to another - another reason it's hard to predict surgical outcomes.

This is actually exactly how I feel. I've had surgeons educated in ADR here in Seattle tell me that I'm not a good candidate and others in Texas tell me I am. I don't feel like there's enough confidence here from physicians/surgeons to sway me.

This is coming from a 34 year old who had a failed discectomy in 2001 and just went to the ER yesterday. Just to put things in perspective.

[laid up doc]

will keep ya'll posted... procedure is next week, just got my brace in the mail today. silver surfer, you will find that many things are regional and that there are biases everywhere. my uncle is a sports med ortho and needed a cervical fusion... he got 6 or 7 opinions before he made a decision. not something to be taken lightly for sure!

[laid up doc]

whole procedure wasn't all that different than my discogram... i had this one under conscious sedation w/ versed/fentanyl rather than monitored anesthesia care w/ propofol (long story!) - for reasons i can't explain, this one was less uncomfortable. set up on table, prepped, felt some local then i don't remember anything until i felt a dull ache in my lower back which was the radiofrequency "lesioning" of the disc. finished up, pulled out probes, then i had the brace put on my back and was helped to roll on to the table.

still somewhat achy, really the worst part is sleeping in the brace. is this required after ADR? anyone have any suggestions how to sleep in the damn thing? i haven't yet slept over 90 minutes despite taking baclofen 10mg and 2 percocet 5/325mg! usually 1 percocet would knock me out, and i wasn't on much in the way of narcs preop.

all in all not a bad procedure... will need a few wks to know if it worked to alleviate my disc pain. i start PT in 2 wks.

[Keano16]

Looking forward to your success story after few weeks. Please keep us updated as I am very interested in biacuplasty. Regards.

[laid up doc]

will do keano, still too early to make any judgments since i'm in the brace and can't/shouldn't do things to stress the disc. am still having a lot of spasms which is not unexpected since i can't stretch to alleviate it and am in this artificial position all day/night. also i have had issues for almost 2 yrs straight now and soft tissue takes a while to chill out. they seem to be improving though. and i'm finally sleeping better thanks to trazodone and ambien... hate narcs anyway.