Assietti Roberto, Morosi Mario, Migliaccio Giovanni, Meani Luigi, Block Jon E
Department of Neurosurgery Ospedale Fatebenefratelli E Oftalmico, Milano, Italy.
Acta Neurochir Suppl. 2011;108:103-5. doi: 10.1007/978-3-211-99370-5_15.
Degeneration of the intervertebral disc can be the source of severe low back pain. Intradiscal electrothermal therapy (IDET) is a minimally invasive treatment option for patients with symptomatic internal disc disruption nonresponsive to conservative medical care.
Using MRI and discographic findings, 50 patients with lumbar discogenic pain were identified, underwent IDET treatment and were followed for 24 months. Outcomes included assessments of back pain severity by an 11-point numeric scale and back function by the Oswestry disability index (ODI).
There was an average 68 and 66% improvement in pain and ODI, respectively, between pre-treatment and 24 months (p < 0.0001 for both comparisons). The global clinical success rate was 78% (39 of 50). Clinical success was associated with discographic concordance (p < 0.0001), HIZ (p = 0.003), Pfirrmann grade (p = 0.0002), and percent annulus coverage (p < 0.0001).
The findings of this study suggest that durable clinical improvements can be realized after IDET in highly selected patients with mild disc degeneration, confirmatory imaging evidence of annular disruption and concordant pain provocation by low pressure discography.
椎间盘退变可能是严重腰痛的根源。椎间盘内电热疗法（IDET）是一种微创治疗方法，适用于对保守治疗无反应的有症状椎间盘内部破裂患者。
利用磁共振成像（MRI）和椎间盘造影结果，确定了50例腰椎间盘源性疼痛患者，对其进行了IDET治疗，并随访24个月。结果包括用11点数字量表评估背痛严重程度，并用Oswestry功能障碍指数（ODI）评估背部功能。
治疗前至24个月时，疼痛和ODI平均分别改善了68%和66%（两项比较的p值均<0.0001）。总体临床成功率为78%（50例中的39例）。临床成功与椎间盘造影一致性（p<0.0001）、高阻抗区（HIZ，p=0.003）、Pfirrmann分级（p=0.0002）和纤维环覆盖百分比（p<0.0001）相关。
本研究结果表明，对于经过严格筛选、患有轻度椎间盘退变、有影像学证据证实纤维环破裂且经低压椎间盘造影诱发疼痛一致的患者，IDET治疗后可实现持久的临床改善。
