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J Neurol Surg A Cent Eur Neurosurg 2017; 78(06): 529-534
DOI: 10.1055/s-0037-1604361
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Transforaminal Epiduroscopic Laser Ablation of Sinuvertebral Nerve in Patients with Chronic Diskogenic Back Pain: Technical Note and Preliminary Result

Hyeun Sung Kim
1   Department of Neurosurgery, Nanoori Hospital, Suwon, Republic of Korea
,
Byapak Paudel
1   Department of Neurosurgery, Nanoori Hospital, Suwon, Republic of Korea
2   Department of Orthopaedics and Traumatology, Grande Int. Hospital, Kathmandu, Bagmati, Nepal
,
Sung Kyun Chung
1   Department of Neurosurgery, Nanoori Hospital, Suwon, Republic of Korea
,
Jee Soo Jang
1   Department of Neurosurgery, Nanoori Hospital, Suwon, Republic of Korea
,
Seong Hoon Oh
3   Department of Neurosurgery, Nanoori Hospital, Bupyeong-gu, Incheon, Republic of Korea
,
Il Tae Jang
4   Department of Neurosurgery, Nanoori Hospital, Gangnam-gu, Seoul, Republic of Korea
› Author Affiliations
Further Information

Publication History

06 March 2017

24 May 2017

Publication Date:
04 September 2017 (online)

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Abstract

Background Diskogenic back pain is an unsolved mystery and accounts for a large number of patients with chronic low back pain. Various treatment modalities have been described, but treatment is still a matter of debate. We evaluated transforaminal epiduroscopic laser ablation (TELA) focusing on sinuvertebral nerve laser ablation for chronic diskogenic back pain. To our knowledge this is the first treatment described for diskogenic back pain that directly targets the sensitized sinuvertebral nerve extradiskally through a transforaminal approach.

Methods A total of 52 patients with a diagnosis of chronic diskogenic back pain and treated with TELA between September 2015 and June 2016 were analyzed. Outcome was measured with the visual analog scale (VAS), Macnab criteria, and Oswestry Disability Index (ODI).

Results Of the 52 patients, 55.8% were female, and the mean age was 42.40 ± 11.99 years. Pfirrmann disk degeneration grade was mostly grade IV (63.5%) and involved spinal levels L4–L5 and L5–S1. The average follow-up period was 15.88 ± 1.79 months. VAS decreased significantly after TELA (p < 0.001). Improvement in ODI was also significant (p < 0.001). Good to excellent outcome was 96.1% according to the Macnab criteria. Four patients had transient motor weakness.

Conclusion TELA targeting to the sinuvertebral nerve was effective in 96.1% with good to excellent results and an immediate decrease in chronic diskogenic back pain. The sinuvertebral nerve may play an important role in chronic diskogenic back pain.

Keywords

diskogenic back pain - sinuvertebral nerve - laser ablation - transforaminal epiduroscopic laser ablation
 

  • References

  • 1 Hicks GE, Morone N, Weiner DK. Degenerative lumbar disc and facet disease in older adults: prevalence and clinical correlates. Spine 2009; 34 (12) 1301-1306
    CrossrefPubMedGoogle Scholar
  • 2 Frymoyer JW. Back pain and sciatica. N Engl J Med 1988; 318 (05) 291-300
    CrossrefPubMedGoogle Scholar
  • 3 Brennan G, Shafat A, Mac Donncha C, Vekins C. Lower back pain in physically demanding college academic programs: a questionnaire based study. BMC Musculoskelet Disord 2007; 8: 67
    CrossrefPubMedGoogle Scholar
  • 4 Anderson DG, Tannoury C. Molecular pathogenic factors in symptomatic disc degeneration. Spine J 2005; 5 (6, Suppl): 260S-266S
    CrossrefPubMedGoogle Scholar
  • 5 Zhang YG, Guo TM, Guo X, Wu SX. Clinical diagnosis for discogenic low back pain. Int J Biol Sci 2009; 5 (07) 647-658
    PubMedGoogle Scholar
  • 6 Osman SG, Sherlekar S, Malik A. , et al. Endoscopic trans-iliac approach to L5-S1 disc and foramen—a report on clinical experience. Int J Spine Surg 2014; 8 DOI: 10.14444/1020.
    CrossrefPubMedGoogle Scholar
  • 7 Comer C, Conaghan PG. Tackling persistent low back pain in primary care. Practitioner 2009; 253 (1721): 32-34 , 3
    PubMedGoogle Scholar
  • 8 Rozenberg S, Foltz V, Fautrel B. Treatment strategy for chronic low back pain. Joint Bone Spine 2012; 79 (06) 555-559
    CrossrefPubMedGoogle Scholar
  • 9 Balagué F, Mannion AF, Pellisé F, Cedraschi C. Non-specific low back pain. Lancet 2012; 379 (9814): 482-491
    CrossrefPubMedGoogle Scholar
  • 10 Kirkaldy-Willis WH, Farfan HF. Instability of the lumbar spine. Clin Orthop Relat Res 1982; (165) 110-123
    PubMedGoogle Scholar
  • 11 Butler D, Trafimow JH, Andersson GB, McNeill TW, Huckman MS. Discs degenerate before facets. Spine 1990; 15 (02) 111-113
    CrossrefPubMedGoogle Scholar
  • 12 Peng BG. Pathophysiology, diagnosis, and treatment of discogenic low back pain. World J Orthop 2013; 4 (02) 42-52
    CrossrefPubMedGoogle Scholar
  • 13 Guyer RD, Ohnmeiss DD. Lumbar discography. Position statement from the North American Spine Society Diagnostic and Therapeutic Committee. Spine 1995; 20 (18) 2048-2059
    CrossrefPubMedGoogle Scholar
  • 14 Maus TP, Aprill CN. Lumbar diskogenic pain, provocation diskography, and imaging correlates. Radiol Clin North Am 2012; 50 (04) 681-704
    CrossrefPubMedGoogle Scholar
  • 15 Kim HS, Jang KS. A rapid pain management and possible mechanism of severe acute low back pain after traumatic event: a comparative analysis of spinal injection therapy with segmental 3-column theory. Asian J Pain 2016; 2 (01) 22-28
    PubMedGoogle Scholar
  • 16 Pauza KJ, Howell S, Dreyfuss P, Peloza JH, Dawson K, Bogduk N. A randomized, placebo-controlled trial of intradiscal electrothermal therapy for the treatment of discogenic low back pain. Spine J 2004; 4 (01) 27-35
    CrossrefPubMedGoogle Scholar
  • 17 Freeman BJ. IDET: a critical appraisal of the evidence. Eur Spine J 2006; 15 (Suppl. 03) S448-S457
    CrossrefPubMedGoogle Scholar
  • 18 Helm S, Hayek SM, Benyamin RM, Manchikanti L. Systematic review of the effectiveness of thermal annular procedures in treating discogenic low back pain. Pain Physician 2009; 12 (01) 207-232
    PubMedGoogle Scholar
  • 19 Kapural L, Vrooman B, Sarwar S. , et al. A randomized, placebo-controlled trial of transdiscal radiofrequency, biacuplasty for treatment of discogenic lower back pain. Pain Med 2013; 14 (03) 362-373
    CrossrefPubMedGoogle Scholar
  • 20 Singh K, Ledet E, Carl A. Intradiscal therapy: a review of current treatment modalities. Spine 2005; 30 (17, Suppl): S20-S26
    CrossrefPubMedGoogle Scholar
  • 21 Jo DH, Yang HJ. The survey of the patient received the epiduroscopic laser neural decompression. Korean J Pain 2013; 26 (01) 27-31
    CrossrefPubMedGoogle Scholar
  • 22 Bogduk N, Tynan W, Wilson AS. The nerve supply to the human lumbar intervertebral discs. J Anat 1981; 132 (Pt 1): 39-56
    PubMedGoogle Scholar
  • 23 Lee SH, Kang HS. Percutaneous endoscopic laser annuloplasty for discogenic low back pain. World Neurosurg 2010; 73 (03) 198-206 ; discussion e33
    CrossrefPubMedGoogle Scholar