Kapural Leonardo, Hayek Salim, Malak Osama, Arrigain Susana, Mekhail Nagy
Department of Pain Management, The Cleveland Clinic FoundatioN, Cleveland, Ohio 44195, USA.
Pain Med. 2005 Nov-Dec;6(6):425-31. doi: 10.1111/j.1526-4637.2005.00073.x.
Two minimally invasive techniques have been used more recently as a possible treatment for painful internal disk disruption (IDD). Intradiscal thermal annuloplasty (IDTA), known as IDET, has already shown promising results in pain reduction and functional restoration. The second technique, radiofrequency posterior annuloplasty (RFA), is used in many interventional pain practices, although studies on the technique's efficacy are lacking. This study compares the effectiveness of those two methods.
We matched 42 patients (21 had IDTA and 21 radiofrequency annuloplasty) for age, sex, weight, smoking history, manual labor, and number of intervertebral disks treated. Enrolled patients completed pain disability index (PDI) questionnaires before receiving either IDTA or RFA; at 2 weeks; and 2, 3, 6, 9, and 12 months following either treatment.
From the third to the twelfth month after the procedure, the IDTA group had significantly lower mean pain scores than the RFA group. Visual analog scale (VAS) pain scores decreased from 6.6 +/- 2.0 before to 4.4 +/- 2.4 at 1 year after radiofrequency annuloplasty (P = 0.001), while in the IDTA group the average VAS pain score decreased from 7.4 +/- 1.9 before IDTA to 1.4 +/- 1.9 at 1 year follow-up. Similarly, PDI scores in the IDTA group had a significantly larger improvement than those for patients who received radiofrequency annuloplasty.
This study shows significant improvement in pain scores and patients' PDI following IDTA but not after RFA of the intervertebral disks. IDTA appears to be more efficacious than RFA based on PDI and VAS scores measured at 1 year following procedure.
最近，两种微创技术已被用作治疗疼痛性椎间盘内紊乱（IDD）的可能方法。椎间盘内热环成形术（IDTA），即众所周知的IDET，已在减轻疼痛和功能恢复方面显示出有前景的结果。第二种技术，射频后环成形术（RFA），在许多介入性疼痛治疗中使用，尽管缺乏关于该技术疗效的研究。本研究比较这两种方法的有效性。
我们根据年龄、性别、体重、吸烟史、体力劳动以及治疗的椎间盘数量，将42例患者（21例行IDTA，21例行射频环成形术）进行匹配。纳入的患者在接受IDTA或RFA之前、2周时以及治疗后的2、3、6、9和12个月完成疼痛残疾指数（PDI）问卷。
在手术后第三个月至第十二个月，IDTA组的平均疼痛评分显著低于RFA组。射频环成形术后，视觉模拟量表（VAS）疼痛评分从术前的6.6±2.0降至术后1年的4.4±2.4（P = 0.001），而在IDTA组，平均VAS疼痛评分从IDTA术前的7.4±1.9降至1年随访时的1.4±1.9。同样，IDTA组的PDI评分改善明显大于接受射频环成形术的患者。
本研究表明，椎间盘IDTA术后疼痛评分和患者的PDI有显著改善，但RFA术后未出现这种情况。根据术后1年测量的PDI和VAS评分，IDTA似乎比RFA更有效。
