Thermal Annuloplasty Using Percutaneous Endoscopic Discectomy for Elite Athletes with Discogenic Low Back Pain

Abstract

The purpose of this study was to assess the usefulness of radiofrequency thermal annuloplasty (TA) using percutaneous endoscopic discectomy/TA (PED/TA) in elite athletes with discogenic low back pain. Twelve patients (11 men, 1 woman; mean age 27.9 years) underwent PED/TA under local anesthesia. Clinical data for these patients (17 affected intervertebral discs), including type of sport played, average duration of low back pain, disc level affected, presence or absence of a high signal intensity zone on magnetic resonance imaging, and whether the patient returned to playing competitive sport, were retrospectively reviewed. The most common sport played by the patient was baseball (n = 8), followed by cycling (n = 2), tennis (n = 1), and hammer throw (n = 1). The average duration of low back pain was 24.3 months. The intervertebral disc levels affected were L4/5 (n = 11) and L5/S1 (n = 6). A high signal intensity zone was detected in nine discs. Although two patients required additional surgery, all patients were able to return to their original competitive level of play. Duration for the return to play was 2.8 months after surgery except the two revision cases. PED/TA for discogenic pain enables an early return to competitive sports, and so is particularly useful for elite athletes.

Keywords: elite athletes; low back pain; percutaneous endoscopic discectomy; thermal annuloplasty.

Fig. 1.

Panel shows a bipolar probe coagulating a damaged annulus in which a high signal intensity zone and a painful annular tear are causing low back pain. Arrow indicate painful annulus tears with redness.

Fig. 2.

(A) Sagittal and axial T₂-weighted images showing a high signal intensity zone indicated by arrow at the level of L4/5 in a 30-year-old female hammer throw player (Case 1). (B) Computed tomography images of discography. The contrast medium can be seen entering the posterior annulus where the high intensity signal zone is located. (C) Low back pain is confirmed to be reproducible by discography at L4–5.

Fig. 3.

(A) Sagittal and axial T₂-weighted images that are HIZ (−) at the L4/5 level and HIZ (+) at the L5/S1 level in a 30-year-old male baseball player (Case 2). Arrows indicate bulging disc at L4/5 and HIZ at L5/S1. (B) CT images of discography showing leakage of contrast material indicated by arrow into the posterior annulus fibrosus at both intervertebral disc levels. (C) Discography and discoblock achieved reproducible low back pain and temporary pain relief at both intervertebral disc levels.