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Letter to the Editor

The Korean Journal of Pain 2019; 32(4): 313-314

Published online October 1, 2019 https://doi.org/10.3344/kjp.2019.32.4.313

Copyright © The Korean Pain Society.

Questions and comments on the efficacy of transforaminal laser annuloplasty versus intradiscal radiofrequency annuloplasty for discogenic low back pain

Daehyun Jo

Pain Center, Pohang Wooridul Hospital, Pohang, Korea

Correspondence to:Daehyun Jo
Pain Center, Pohang Wooridul Hospital, 256 Poseuko-daero, Buk-gu, Pohang 37755, Korea
Tel: +82-54-240-6000, Fax: +82-54-240-6195, E-mail: pandjo@naver.com

Received: May 8, 2019; Revised: May 20, 2019; Accepted: May 21, 2019

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

LETTER TO THE EDITOR

I read the article titled ‘Efficacy of transforaminal laser annuloplasty versus intradiscal radiofrequency annuloplasty for discogenic low back pain’ authored by Park et al. [1]. It is an interesting paper to the interventional pain physician. I would like to point out some issues. As the authors said, there are a lot of treatment modalities for chronic discogenic pain. So, we need appropriate patient selection according to the indications before doing invasive treatments. According to the authors, the inclusion criteria included an annular tear of the disc, and the exclusion criteria included a herniated intervertebral disc [2,3]. Did they do discography for all the patients? If not, how did they confirm the annular tear without the herniated disc? It would have been better to show us the evidence of the distinction between an annular tear and a herniated disc.

When the authors did transforaminal epiduroscopic laser annuloplasty (TELA), they removed the disc material using forceps, which means it was a percutaneous endoscopic lumbar discectomy (PELD). Does that mean that they did a PELD with a TELA? We need some endoscopic pictures from the TELA, which would help the readers to understand their procedures. The authors described the intradiscal radiofrequency annuloplasty (IDRA) procedure in Materials and Methods, which said that ‘After placement of the cannula, granulation tissue could often be visualized, with spinal scope (LASE, Minneapolis, MN). However, in the discussion on page 118 in the left column, they described their IDRA as being under C arm fluoroscopy, rather than being performed endoscopically’.

It looks like they used transforaminal laser annuloplasty (TFLA) and TELA for the same procedure. If not, we need to establish their definitions for TFLA and TELA, and correct the overuse of abbreviations, which obstruct and interrupt scientific communication.

  1. Park CH, Lee KK, Lee SH. Efficacy of transforaminal laser annuloplasty versus intradiscal radiofrequency annuloplasty for discogenic low back pain. Korean J Pain 2019;32:113-9.
    Pubmed KoreaMed CrossRef
  2. Fardon DF, Milette PC, Combined Task Forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology. Nomenclature and classification of lumbar disc pathology. Recommendations of the Combined task Forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology. Spine (Phila Pa 1976) 2001;26:E93-113.
    CrossRef
  3. Fardon DF, Williams AL, Dohring EJ, Murtagh FR, Gabriel Rothman SL, Sze GK. Lumbar disc nomenclature: version 2.0: Recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology. Spine J 2014;14:2525-45.
    Pubmed CrossRef