Description:
Chronic back pain is a common condition that affects a considerable proportion of the population. In most individuals the pain resolves spontaneously within several months. However, for some people the pain persists, despite specific causes of back pain such as herniated discs, osteoporosis and fractures being excluded. Increasingly, this pain is being attributed to degeneration of the intervertebral disc, and referred to as discogenic back pain.
Typically, first-line treatment for chronic discogenic back pain is conservative, consisting of pharmacotherapy and/or a multidisciplinary programme which may include exercises, education and behavioural therapy. Where these regimes have failed, patients may then choose to continue with conservative management or to undergo surgery (spinal fusion). Intradiscal electrothermal therapy is indicated for patients with discogenic lower back pain who have not responded to conservative treatment and who have opted not to have surgery.
Percutaneous intradiscal electrothermal therapy is normally performed under local anaesthetic and light sedation. An introducer needle is inserted into the painful disc under fluoroscopic guidance. An electrode or flexible catheter is then introduced into the disc through the needle and is guided to a position covering the entire posterior wall of the disc. Once in position, the catheter is slowly heated up to 90°C and kept at that temperature for 15-17 minutes.
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