Thermal-Induced Osteonecrosis of Adjacent Vertebra after Intradiscal Electrothermal Therapy

A 42-year-old man was admitted to our hospital with complaints of low back pain and intermittent right thigh pain. Twelve weeks before admission, the patient received intradiscal electrothermal therapy (IDET) at a local hospital. The patient still reported low back pain after the procedure that was managed with narcotic analgesics. Follow-up magnetic resonance imaging (MRI) was performed, and his referring physician thought the likely diagnosis was spondylodiscitis at the L4–5 spinal segment with a small epidural abscess. At admission to our department, the patient reported aggravated low back pain. Blood test results, including the erythrocyte sedimentation rate and C-reactive protein levels, were slightly elevated. Biopsy samples of the L4, L5 vertebral bodies and disk were obtained. The material underwent aerobic, anaerobic, fungal, mycobacterial cultures and histologic examination. Results of all cultures were negative. Histologically, necrosis of the bone was evident from the number of empty osteocyte lacunae. In addition, there was no evidence of infection based on biopsy results. No antibiotic treatment was administered on discharge. Repeat computed tomography and MRI performed 12 months after IDET showed a bony defect in the L4 and L5 vertebral bodies, and a decrease in the size of the L4–5 intervertebral disc lesion. We report a case of lumbar vertebral osteonecrosis induced by IDET and discuss etiology and radiologic features.

Results of Intradiscal Pulsed Radiofrequency for Lumbar Discogenic Pain: Comparison with Intradiscal Electrothermal Therapy

BACKGROUND: We have developed an intradiscal pulsed radiofrequency (Disc PRF) technique, using Diskit II(R) needles (NeuroTherm, Wilmington, MA, USA), as a minimally invasive treatment option for chronic discogenic low back pain (LBP). The purpose of this study was to compare the representative outcomes of Disc PRF and Intradiscal Electrothermal Therapy (IDET) in terms of pain relief and reduction of disability. METHODS: Thirty-one patients with chronic discogenic LBP who underwent either Disc PRF (n = 15) or IDET (n = 16) were enrolled in the study. A Diskit II(R) needle (15-cm length, 20-gauge needle with a 20-mm active tip) was placed centrally in the disc. PRF was applied for 15 min at a setting of 5 x 50 ms/s and 60 V. The pain intensity score on a 0-10 numeric rating scale (NRS) and the Roland-Morris Disability Questionnaire (RMDQ) were assessed pretreatment and at 1, 3, and 6 months post-treatment. RESULTS: The mean NRS was significantly improved from 7.2 +/- 0.6 pretreatment to 2.5 +/- 0.9 in the Disc PRF group, and from 7.5 +/- 1.0 to 1.7 +/- 1.5 in the IDET group, at the 6-month follow-up. The mean RMDQ also showed significant improvement in both the Disc PRF group and the IDET group at the 6-month follow-up. There were no significant differences in the pretreatment NRS and RMDQ scores between the groups. CONCLUSIONS: Disc PRF appears to be an alternative to IDET as a safe, minimally invasive treatment option for patients with chronic discogenic LBP.

The clinical effectiveness of percutaneous lumbar diskectomy combined with intradiscal electrothermal therapy for lumbar disc herniation / 介入放射学杂志

0.01). No serious complications occurred. Conclusion Both PLD+IDET and PLD are very effective in treating lumbar disc herniation. IDET is very helpful in relieving low back pain, although it can hardly improve patient's daily activities.