Authors' objectives:

This study aims to summarise the available evidence on radiofrequency techniques for the management of lumbar discopathy (discal nucleoplasty, percutaneous thermocoagulation and electrothermal annuloplasty).

Authors' results and conclusions: Percutaneous intradiscal radiofrequency thermocoagulation (PIRT): In the only RCT found, which compared the procedure against conventional treatment, 28 patients were included and no statistically significant differences were found as regards levels of pain before and after the procedure. In a series of cases published by Van Kleef et al, 54% of patients attained an adequate reduction of pain after a follow up of 8 weeks. Intradiscal electrothermal percutaneous annuloplasty (IDET): Most patients included in the studies reported pain reduction after the procedure as measured by the analog visual scale (VAS). In the RCT published by Pauza et al. (68 patients), 78% of the patients reported pain reduction after 6 months the procedure was carried out, compared to 46% of the patients from the control group. However, pain reduction was poor; it could be reduced to 50% in less than 40% of the patients. The case series reported heterogeneous results without being clearly consistent. Intradiscal nucleoplasty or coblation: The results with this technique come from the 3 series of cases found. In Singh's study where 89 patients were followed one year long, 75% of patients reported that the pain had reduced and in 54% this reduction was higher than 50% of relieve at the end of the follow up period. The other two series of cases showed poorer results. No adverse effects were reported with these procedures in the trials assessed, though there are cases of cauda equina and vertebral osteonecrosis due to intradiscal electrothermal therapy.

Authors' recommendations: Radiofrequency techniques are new technologies and little information is published about them. The data come mostly from observational studies of poor-level evidence whose main limitation is lack of comparison against control groups treated using conventional strategies (analgesics and physical therapy). This limitation is particularly significant in pathologies such as low back pain which presents a high rate of spontaneous resolution. This makes it difficult to draw conclusions about the efficacy of the procedures and their mid and long term safety. The coverage policies found consider these investigational techniques as with no evidence of proven efficacy. The evidence currently available on the three techniques does not support the use of these procedures on routine basis beyond the research framework.

Authors' methods: Overview

Project Status: Completed

URL for project: http://www.iecs.org.ar/

Year Published: 2005

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Argentina

Organisation Name: Institute for Clinical Effectiveness and Health Policy

Contact Address: Dr. Emilio Ravignani 2024, Buenos Aires - Argentina, C1414 CABA

Contact Name: info@iecs.org.ar

Contact Email: info@iecs.org.ar

Copyright: Institute for Clinical Effectiveness and Health Policy (IECS)