Description:
Chronic back pain is a common condition. 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 typically 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 radiofrequency thermocoagulation is particularly indicated in patients with persistent lower back pain.
Percutaneous intradiscal radiofrequency thermocoagulation is a procedure that allows the controlled delivery of heat to the intervertebral disc via an electrode or coil. Patients are sedated and local anaesthetic is infiltrated over the affected disc. Under fluoroscopic guidance, a needle is inserted into the disc. The electrode or flexible catheter is then introduced into the centre of the nucleus through the needle, slowly heated to 50-80°C and kept at that temperature for 90-360 seconds.
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