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INTRADISCAL ELECTROTHERMAL ANNULOPLASTY

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Voir éga­le­ment :Clas­si­fi­ca­tion des lésions dis­cales lom­baires (Pr J.Y. Maigne)

Revo­lu­tio­na­ry Treat­ment for Chro­nic Back Pain
SOURCE Mea­dow­lands Hos­pi­tal Medi­cal Center

Two Mea­dow­lands Hos­pi­tal Medi­cal Cen­ter phy­si­cians have intro­du­ced the revo­lu­tio­na­ry new Intra­dis­cal Elec­tro­ther­mal Annu­lo­plas­ty pro­ce­dure, also known as (IDET) to the New York metro­po­li­tan area.
Sri Kan­tha, M.D. and Ari Ben-Yishay, M.D. have been per­for­ming this pro­ce­dure at Mea­dow­lands Hos­pi­tal for the past seve­ral months, trea­ting 12 patients suf­fe­ring from severe low back pain and suc­cess­ful­ly achie­ving pain relief.
Dr. Kan­tha, a Pain Mana­ge­ment expert and Medi­cal Direc­tor of the Mea­dow­lands Pain Mana­ge­ment Cen­ter and Dr. Ben-Yishay, a noted spine sur­geon, have pio­nee­red this pro­ce­dure in the New York metro­po­li­tan area. Cur­rent­ly, Mea­dow­lands Pain Mana­ge­ment Cen­ter is the only faci­li­ty offe­ring this pro­ce­dure for the relief of back pain in this area.

The pro­ce­dure, which was deve­lo­ped in Cali­for­nia by Stan­ford spine spe­cia­list Dr. Jef­fe­ry Saal and his bro­ther, Dr. Joel Saal, was publi­ci­zed in News­week, March 15, 1999 and was recent­ly pro­fi­led on NBC’s « Dateline. »
This pro­ce­dure consists of inser­ting a spe­cial cathe­ter with a hea­ting ele­ment at the tip intro­du­ced through a six-inch long needle in to the patient’s disc area. The needle is inser­ted through the skin without any open sur­ge­ry. The hea­ting ele­ment is connec­ted to a machine that gene­rates elec­tro­ther­mal heat up to 194 degrees F for a total of 15 minutes. The heat dea­dens the pain­ful area of the disc and also helps to har­den the affec­ted disc, thus alle­via­ting the pain.

The IDET pro­ce­dure is an alter­na­tive to a lum­bar fusion and is done under local anes­the­sia and takes approxi­ma­te­ly 30 minutes com­pa­red to fusion which could take up to seve­ral hours and is per­for­med under gene­ral anes­the­sia with recu­pe­ra­tion of seve­ral days to months. The recu­pe­ra­tion from IDET is a few days with neces­sa­ry pre­cau­tions taken to avoid lum­bar sprain. For infor­ma­tion on this and other Pain Mana­ge­ment pro­ce­dures contact Sri Kan­tha, M.D. at 201–392-3585.


INTRADISCAL ELECTROTHERMAL ANNULOPLASTY Source : http://www.spinalinjection.com/ISIS1/newsltrs/nl1998j/untitl6.htm
Richard Der­by MD – Bjorn Eek MD – Dea­glán P. Ryan MS
Intro­duc­tion : Intra­dis­cal Elec­tro­ther­mal Annu­lo­plas­ty (IEA or IDET) is a rela­ti­ve­ly new pro­ce­dure to heat the inter­ver­te­bral disc for the pur­pose of relie­ving dis­co­ge­nic pain. This abs­tract repre­sents the six-month fol­low-up of the first 20 patients enrol­led into an ongoing pilot stu­dy, whose pur­pose is to inves­ti­gate the long-term effi­ca­cy of the IEA procedure.

Methods and Materials :
The IEA pro­ce­dure uti­lizes an Ora­tec Inter­ven­tions 30cm SPINECath1 cathe­ter, with a 6cm active tip. Uti­li­zing nor­mal dis­co­gra­phic tech­nique, the cathe­ter is inser­ted ante­rior­ly into the annu­lus or nucleus via a 17-gauge intro­du­cer. The active tip is typi­cal­ly advan­ced ante­rior-late­ral­ly inside the nuclear tis­sue, and is direc­ted cir­cui­tous­ly to return pos­te­rio­ral­ly, ideal­ly achie­ving full 360° pene­tra­tion. (Fig. 1) Fol­lo­wing cathe­ter posi­tio­ning, elec­tro­ther­mal heat is gene­ra­ted at the active tip, com­men­cing at 65°C and increa­sing incre­men­tal­ly to (typi­cal­ly) 80°C, for a mean dura­tion of 14 minutes.

From 5/97 to 11/97 we enrol­led our first twen­ty conse­cu­tive patients under­going the IEA pro­ce­dure into a pros­pec­tive out­come stu­dy. Strict inclu­sion and exclu­sion cri­te­ria were adhe­red to. Prior to IEA all patients underwent pres­sure-control­led dis­co­gra­phy to deter­mine the num­ber of symp­to­ma­tic discs, the loca­tion of annu­lar tears, and to cate­go­rize the sen­si­ti­vi­ty of the disc annu­lus to pressurization.

Results :
Out­come at 6 months was asses­sed by exa­mi­ning changes bet­ween the base­line ques­tion­naire (admi­nis­te­red to each patient just prior to their under­going the IEA pro­ce­dure) and a six month fol­low-up ques­tion­naire. Two pri­ma­ry com­pa­ra­tive out­come ins­tru­ments were uti­li­zed. A mean 2 point decrease on a 10-point visual ana­logue pain scale was found (p<.05). An ana­ly­sis of the 24-point Roland & Mor­ris Disa­bi­li­ty ques­tion­naire retur­ned a mean 2.2 point decrease in disa­bi­li­ty, which was found to be non-significant.
At fol­low-up, patients” satis­fac­tion with the pro­ce­dure and its out­come were exa­mi­ned on a modi­fied 4‑point NASS Patient Satis­fac­tion Index. 73% of the sample were satis­fied with their out­come, repor­ting that they would repeat the pro­ce­dure for the same out­come. 27% felt them­selves to be the same or worse than before under­going the IEA pro­ce­dure. At fol­low-up, five sub­jec­tive impro­ve­ment-in-acti­vi­ty variables were also exa­mi­ned. 53% of the sample repor­ted an impro­ve­ment in gene­ral ove­rall acti­vi­ty levels, 73% in sit­ting, 47% in stan­ding, 46% in wal­king and 40% repor­ted an impro­ve­ment in their sleeping.

Conclu­sions :
In the ear­ly stages of inves­ti­ga­tion, intra­dis­cal elec­tro­ther­mal annu­lo­plas­ty appears pro­mi­sing as a tech­nique to reduce chro­nic pain of dis­co­ge­nic ori­gin. Fur­ther stu­dy is war­ran­ted, both to com­pare effi­ca­cy against other intra­dis­cal hea­ting pro­ce­dures and to assess the pre­cise patho­lo­gy most suc­cess­ful­ly trea­ted by the pro­ce­dure. The cur­rent stu­dy is ongoing, and the 12-month fol­low-up results will be pre­sen­ted as time allows.


Fig 1 : Typi­cal cathe­ter placement

1 The SPI­NE­Cath cathe­ter is manu­fac­tu­red & dis­tri­bu­ted by Ora­tec Inter­ven­tions. Phy­si­cians requi­ring fur­ther infor­ma­tion on equip­ment or pro­ce­dure may contact Ora­tec Inter­ven­tions at 3700 Haven Court, Men­lo Park, CA 94025. (Tel (650) 369‑9904) Please note, none of the authors hold any inter­est in this company.

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