Minimal-invasive pain procedures are effective in different degenerative pain generators in CLBP: A prospective cohort study

Abstract

Background: It is estimated that a significant number of spinal surgeries are performed, but many patients do not often benefit.

Objective: Our aim was to determine how effective minimally invasive pain procedures (MIP) are in chronic low back pain (CLBP) patients with proven degenerative causes (specific low back pain).

Methods: 386 eligible patients with CLBP/sciatica resistant to conservative therapy and scheduled for open surgery were screened, and 167 could be enrolled in this study. Indications for MIP in the remaining 150 individuals were made by one experienced spinal surgeon. Before and 6 months after the intervention, the numeric rating scale (NRS) and Oswestry Disability Index (ODI) were recorded. MIP was performed, such as radiofrequency of the facet and SI-joint, intradiscal electrothermal therapy in case of discogenic pain, as well as epidural neuroplasty in patients with disc herniation/epidural fibrosis.

Results: There was a statistically significant decrease in NRS (p< 0.05), as well as a significant increase in ODI (p< 0.001) 6 months after the procedures. This was also true for the results of all different pain generators and subsequent performed procedures alone.

Conclusions: The indication of MIP should be routinely reviewed in patients with CLBP to avoid potentially open surgery and a burden on healthcare costs.

Keywords: Minimal invasive surgical procedures; disc herniation; discogenic pain; low back pain mechanical; sciatica.

Figure 1.

Fluoroscopy–guided radiofrequency of the medial ramus L3 bilateral status post total discs L4/5 and L5/S1.

Figure 2.

Fluoroscopy–guided radiofrequency of the lateral branches (Sacroiliac-Joint) with Simplicity^®.

Figure 3.

Fluoroscopy–guided epidural neuroplasty catheter placed left L5/S1 with contrast.

Figure 4.

Fluoroscopy–guided Intradiscal elektrothermal therapy (IDET) probe in L5/S1.

Figure 5.

Flow chart of the prospective observational trial. $n=$ 116 were excluded ($n=$ 21 surgery within preceeding 6 months, $n=$ 8 infection, $n=$ 31 spinal canal stenosis, $n=$ 12 rheumatologic diseases, $n=$ 10 malignancies, $n=$ 8 application for early retirement pension, $n=$ 26 known anxiety disorder, depression or somatoform disorder). $n=$ 85 having not met inclusion criteria (pain intensity was less than NRS $=$ 5 within the last 6 months).

Figure 6.

Results of the NRS months after different pain procedures. There was a significant decrease in NRS in patients received minimal-invasive procedures. NRS $=$ numeric rating scale, ENP $=$ epidural neuroplasty ($n=$ 24), FD $=$ radiofrequency of the facet joint ($n=$ 79), IDET $=$ intradiscal electrothermal therapy ($n=$ 22), SIJ $=$ radiofrequency of sacro iliac joint ($n=$ 25), 0.001 in comparison to pre-procedure T1, T1 $=$ pre-OP, T2 $=$ 6months post-OP. All data are expressed as mean $\pm$ standard deviation (SD) or as median with confidence interval (CI). Statistical significance was determined using Shapiro-Wilk-Test and Wilcoxon-test within the groups according to the distribution of data and according to paired or independent samples. $P$-values 0.05 were considered significant.

Figure 7.

Results of the ODI 6 months after all pain procedures. There was a significant decrease in ODI in patients received minimal-invasive procedures. ODI $=$ Oswestry-Disability-Index, ENP $=$ epidural neuroplasty ($n=$ 24), FD $=$ radiofrequency of the facet joint ($n=$ 79), IDET $=$ intradiscal electrothermal therapy ($n=$ 22), SIJ $=$ radiofrequency of sacro iliac joint ($n=$ 25) , 0.001 in comparison to pre-procedure T1, T1 $=$ pre-OP, T2 $=$ 6 months post-OP. All data are expressed as mean $\pm$ standard deviation (SD) or as median with confidence interval (CI). Statistical significance was determined using Shapiro-Wilk-Test and Wilcoxon-test within the groups according to the distribution of data and according to paired or independent samples. $P$-values 0.05 were considered significant.