Webster Barbara S, Verma Santosh, Pransky Glenn S
Liberty Mutual Center for Disability Research, Hopkinton, MA 01748, USA.
Spine (Phila Pa 1976). 2004 Feb 15;29(4):435-41. doi: 10.1097/01.brs.0000092376.41688.1a.
Case series.
To describe the outcomes of workers' compensation (WC) claimants who have had a lumbar intradiscal electrothermal therapy (IDET) procedure.
IDET was developed as a less invasive treatment alternative to fusion after failure of conservative treatment for discogenic low back pain (LBP). Initial IDET case series from single practices have reported improved pain, function, and return to work outcomes. Little is known about results when performed by a variety of providers or in WC populations.
LBP cases that underwent IDET between December 1, 1998 and February 29, 2000 were identified from WC records. Data sources included hardcopy claim files, administrative medical billing data, and computerized claim file narrative reports. Outcomes included narcotic use 6 months or more after IDET, additional invasive treatment after IDET (low back injections or surgery), and improved work status 24 months after IDET.
One hundred forty-two cases from 23 states were identified, with 97 different providers performing the procedure. Mean duration of symptoms before IDET was 26 months. Mean follow-up duration after IDET was 22 months. Ninety-six (68%) of the cases did not meet one or more of the published inclusion criteria. Seventy-eight cases (55%) received at least two narcotic prescriptions 6 months or more after IDET. Fifty-three (37%) had at least one lumbar injection and 32 (23%) had lumbar surgery after IDET. A total of 55 (39%) were working at 24 months after IDET; of these, 28 (20%) were not working and 27 (19%) were working before IDET. Narcotic use after IDET was associated with narcotic use before IDET, the same provider performing discography and IDET (provider self-referral), and positive signs of radiculopathy (C = 0.80). Need for invasive lumbar procedures after IDET were associated with provider self-referral, narcotic use before IDET, and older age (C = 0.73). Continued work absence after IDET was associated with provider self-referral, male gender, litigation, narcotic use before IDET, and older age (C = 0.83). Conformance with published selection criteria for IDET was not associated with provider self-referral or outcomes, nor was duration before IDET associated with outcomes.
The procedure may be less effective when performed by a variety of providers than suggested by initial case series performed by single providers or practices in work-related LBP cases. Provider self-referral and narcotic use before IDET are significant risk factors for poor outcomes. Randomized controlled trials are needed to determine whether there is a subset of patients with discogenic back pain who derive substantial and sustained benefit from this procedure.
病例系列研究。
描述接受腰椎间盘内电热疗法（IDET）的工伤赔偿（WC） claimants的治疗结果。
IDET是作为椎间盘源性下腰痛（LBP）保守治疗失败后一种侵入性较小的融合替代治疗方法而开发的。来自单一医疗机构的最初IDET病例系列报告称疼痛、功能有所改善，且恢复工作情况良好。对于由多种医疗服务提供者实施该手术或在WC人群中的结果知之甚少。
从WC记录中识别出1998年12月1日至2000年2月29日期间接受IDET的LBP病例。数据来源包括纸质索赔文件、行政医疗计费数据和计算机化索赔文件叙述性报告。结果包括IDET后6个月或更长时间的麻醉药物使用、IDET后的额外侵入性治疗（腰背部注射或手术）以及IDET后24个月工作状态的改善。
确定了来自23个州的142例病例，由97位不同的医疗服务提供者实施手术。IDET前症状的平均持续时间为26个月。IDET后的平均随访时间为22个月。96例（68%）病例未满足一项或多项已公布的纳入标准。78例（55%）在IDET后6个月或更长时间接受了至少两张麻醉药物处方。53例（37%）在IDET后至少接受了一次腰背部注射，32例（23%）在IDET后进行了腰椎手术。IDET后24个月共有55例（39%）在工作；其中，28例（20%）术前不工作，27例（19%）术前在工作。IDET后麻醉药物使用与IDET前麻醉药物使用、进行椎间盘造影和IDET的是同一医疗服务提供者（医疗服务提供者自我推荐）以及神经根病阳性体征相关（C = 0.80）。IDET后需要进行侵入性腰椎手术与医疗服务提供者自我推荐、IDET前麻醉药物使用和年龄较大相关（C = 0.73）。IDET后持续缺勤与医疗服务提供者自我推荐、男性、诉讼、IDET前麻醉药物使用和年龄较大相关（C = 0.83）。符合已公布的IDET选择标准与医疗服务提供者自我推荐或结果无关，IDET前的病程与结果也无关。
与单一医疗服务提供者或医疗机构在与工作相关的LBP病例中进行的最初病例系列研究相比，由多种医疗服务提供者实施该手术时可能效果较差。医疗服务提供者自我推荐和IDET前麻醉药物使用是预后不良的重要危险因素。需要进行随机对照试验以确定是否有一部分椎间盘源性背痛患者能从该手术中获得实质性和持续性的益处。
