LINKS:
Doug's Current Treatment Diary:
Basic Anatomy of the Lumbar Disc:
Disc Herniation - How it evolves:
Disc Herniation continued: Pain!
RESEARCH:
Disc Herniation & Radiculopathy Facts:
Pathophysiology of Degenerative Disc Disease:
IMAGES:
MRI - Cervical Anatomy & axial post ACDF:
IDET Research Papers:
Saul & Saul (1) (Year 2002): A large group of chronic pain patients(1116 patients) with back pain for less then 3month were referred to the Saul’s Clinic and started on carefully monitored ‘conservative’ treatment program. This conservative care program included: Medicine, exercise, Physical therapy, spinal care instruction, and at least one fluoroscopic guided epidural steroid injection. 94% of them improved with the six months of conservative care and only 6% of the initial 1116 patients did not improve with conservative care. These 62 remaining patients were given a discogram and accepted as candidates and underwent a one or two level for the IDET procedure.
RESULTS: 4 patients failed to continue the follow-up (conditions unknown) and 1 patient was lost to a spinal fusion at the 6 month mark. 58 patients were followed for 2 years. A VAS and SF-36 were taken at 6 months, 12 months, and 24 months. Both the VAS and the SF-36 (which is much more complicated) showed about the same results. There was a 51% average overall improvement in these patients at a two year follow-up. A very long way from 100% improvement! No one got 100% better in this study. The average VAS ( The old ‘scale of 1 to 10 – “how are you feeling?” system) was a 3.4 rating! Hell I’m about that good right now!! I’m not impressed.
(1) Jeffrey A. Saal, MD; Joel S. Saal, MD From SOAR, Physiatry Medical Group, Menlo Park, California.SPINE 2002;27:966-973
Thompson (2) (year 2002): This was a survey study of SF-36 scores on 205 IDET-treated patients from 42 centers and followed those patients for a minimum of 1 year. The mean SF-36 score changes were 15.8 points for the physical function subscale and 14.9 points for the bodily pain subscale. Liu et al(3) and Singh(4) reported similar findings in their study groups. (I’m guessing around 31% improved)
(2). Thompson K. IDET nationwide registry preliminary results: twelve month follow-up data on 205 patients. 15th Annual Meeting of the North American Spine Society. New Orleans, Louisiana, 2000.
(3). Liu B, Manos R, Criscitiello A, et al. Clinical factors associated with favorable outcomes using intradiscal electrothermal modulation (IDET). 15th Annual Meeting of the North American Spine Society, New Orleans, Louisiana, 2000.
(4). Singh V. Intradiscal electrothermal therapy: a preliminary report. Pain Physician 2000;3:367–73.
Karasek and Bogduk (5)(Year2000): reported on the 1-year outcome of IDET- treated patients ( 35 patients) and compared them with a control group of patients (17 patients) similarly diagnosed but denied insurance authorization for IDET. The researchers used a 50% reduction of VAS (1-10 scale) scores as an indicator of success. On this basis, 60% were considered successes (Meaning they subjectively improved by 50% or more. Eg: Patient Smith was subjectively a 3 out of 10 before the IDET [indicating only 30% improved before the IDET] One year after the IDET, he was subjectively 80% better… get it.) Additionally, they noted that 23% of the patients had total relief of symptoms – 100% better. They reported that only one patient( 6%) in the control group improved and the remainder continued to have similar pain intensity.
(5). Karasek M, Bogduk N. Twelve-month follow-up of a controlled trial of intradiscal thermal annuloplasty for back pain due to internal disc disruption. Spine 2000;25:2601–7.
Derby et al (6) (Year2000) reported that 62.5% of IDET-treated patients had a favorable outcome based on the Roland Morris scale, VAS ( 1 – 10 scale), NASS outcome instrument, and a general activity scale. If patients had preserved disc height and had not undergone previous surgery at the index level, the success rate was 76%.
(6). Derby R, Eck B, Chen Y, et al. Intradiscal electrothermal annuloplasty (IDET): a novel approach for treating chronic discogenic back pain. Neuromodulation 2000;3:69–75.