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24th Annual Meeting
February 13-16, 2008
Orlando, FL
© 2006 American Academy of Pain Medicine
 


Thursday, February 14, 2008
113

Percutaneous Thermal Disc Decompression in Patients With Symptomatic Contained Lumbar Disc Protrusion Refractory to Conservative Treatment: A Prospective Cohort Study

Shawn Dalton-Bethea, MD, William A. Anderson III, MD, Casey J. O'Donnell, DO, Gene V. Levinstein, MD, and William G. Cano, MD. Performance Spine and Sports Physicians, P.C., Pottstown, PA, USA

INTRODUCTION: Percutaneous Thermal Disc Decompression (Acutherm) is a minimally-invasive, outpatient procedure which treats pain caused by contained lumbar disc protrusions through delivery of thermal energy to the base of the protrusion. This prospective cohort study investigated the efficacy of Acutherm in the treatment of leg and back pain caused by contained lumbar disc herniation.

MATERIALS AND METHODS: Patients with back and leg pain secondary to unilateral, contained lumbar disc protrusion as evidenced by MRI, who had failed at least 6 months of conservative treatment, including physical therapy, epidural steroid injections and medications, were deemed eligible for the study. As the study was performed in a private practice setting, IRB approval was not required. Subjects underwent Acutherm treatment under fluoroscopic guidance through a posterolateral approach contralateral to the herniation. All patients completed a 12-minute 90°C decompression protocol. Patients wore an LSO for 6 weeks postprocedure, followed by 4 sessions of outpatient therapy. Follow-up measures were performed at 6 and 12 months.

RESULTS: 21 patients received single-level treatment; 4 patients had two discs treated; a total of 29 procedures were performed. All patients were compliant with post-treatment protocol and follow-up. At 6 months, there was a mean improvement of 3.4 on the VAS and 63% subjective improvement; at 12 months, VAS remained improved by 3.3 points and patients reported 54% improvement. 73% of patients returned to work following treatment. 35% discontinued use of all pain medications. 36% required further treatment for the same pain,including epidural steroid injection and/or surgery. When asked if they would have the procedure again, 81% of the patients replied yes. No complications were observed.

CONCLUSION: Acutherm appears to be a safe and effective treatment for symptomatic contained lumbar disc herniations. A majority of patients experience significant improvement in leg and back pain, persisting for at least one year.


References: 1. Volumetric Reduction of Bovine Intervertebral Discs with the use of an Intradiscal Decompression Catheter. Michael Schaufele MD, Nigel Andrews PhD, James Huckle PhD. Presented at the International Spine Intervention Society 12th Annual Scientific Meeting, September 9 – 11,2004, Maui, Hawai'i.

2. Pain Outcomes and MRI Findings Following Treatment Of Lumbar Disc Herniations With Targeted Disc Decompression. Michael Schaufele MD, David Appleby MPH. Data on file at Smith & Nephew, Andover, MA 01810.

3. Report: Thermal Mapping of Discs Treated with the Smith & Nephew Decompression Catheter. Data on file at Smith & Nephew, Andover, MA 01810.
Funding: None

William A. Anderson III, MD
Nothing to disclose.

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