Good News For Bad Backs! A New Treatment For Painful Disc Degeneration. The use of heat to treat various ailments is not new. Hippocratic use of a flaming brand to the shoulder would cure recurrent dislocations. More recently we have been applying modern “Flaming brands” via an arthroscope to the anterior capsule of the shoulder using radio–frequency probes.
The intervertebral disc presents a particular problem as it has high impedance and fails to allow sufficient energy to be delivered to raise the temperature of the discs to a therapeutic level. This problem has been overcome by a novel method of delivery of the thermal energy from a radio–frequency generator via a special intradiscal catheter–the Spine CATHTM.
A Big Problem Over 60% of the adult population will suffer from significant back pain in their lives and 34% of these will have periods of absence from work because of back pain. The cost of back pain to the patient, in lost income, to society, in lost production, benefit payments and medical care and to the medical and allied professions who treat these patients is immense.
- 61% of all adults have back pain at some time in their lives.
- 34% will loose time of work because of back pain.
While over 90% of acute back pain settles with conservative treatment, the remaining 10% present a significant problem in diagnosis and treatment. For those who’s symptoms are sufficiently severe to undergo further treatment the first problem must be that of defining the site of the pain and the significance of external factors in the patient’s illness. While there are several indicators of the likely pain source, the significance and specificity of these tests is often debated.
Provocative discography, spinal probes, diagnostic injections and MRI findings may suggest the site of the painful locus but have to be taken in context with the whole patient and are not a substitute for good history taking and examination.
IDETTM IDETTM is a method of selectively heating the posterior annulus to 90 degrees centigrade to allow thermal destruction of nociceptors within the degenerate annulus, and to denature the protein of the posterior annulus in such a way that it undergoes a repair process.
The effect of heating the annulus–(Collagen and pain fibers) The lamella structure of the lumbar disc annulus undergoes a process of delamination and fissuring which begins after the nuclear hydrostatic pressure becomes reduced early in the degenerative process. The posterior annulus is principally affected due to high stress concentrations. A partial healing response occurs which leads to the ingrowths of granulation tissue and nerve fibers. The annular nociceptors, through either a direct mechanical stimulus or activation by inflammatory mediators, are becoming widely regarded as the prime contributor to discogenic pain.