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Letter to the Editor

The Korean Journal of Pain 2019; 32(4): 314-315

Published online October 1, 2019 https://doi.org/10.3344/kjp.2019.32.4.314

Copyright © The Korean Pain Society.

Author's reply

Chan Hong Park

Department of Anesthesiology and Pain Medicine, Daegu Wooridul Spine Hospital, Daegu, Korea

Correspondence to:Chan Hong Park
Department of Anesthesiology and Pain Medicine, Daegu Wooridul Spine Hospital, 648 Gukchaebosang-ro, Jung-gu, Daegu 41939, Korea
Tel: +82-53-212-3179, Fax: +82-53-212-3149, E-mail: magary1@daum.net

Received: May 30, 2019; Revised: June 10, 2019; Accepted: June 12, 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.

Body

I would like to thank Dr. Jo for his interest and concerns regarding the transforaminal epiduroscopic laser annuloplasty (TELA) versus intradiscal radiofrequency annuloplasty (IDRA) for patients with symptomatic lumbar discogenic low back pain. I read with interest the letter to the editor regarding our paper comparing TELA and IDRA for discogenic low back pain [1] and I would like to offer the following comments and observations.

  • It is very well known that that provocative discography is a very useful diagnostic tool for confirming the pathologic level for discogenic low back pain. In cases of multilevel annular tear lesions on magnetic resonance imaging, provocative discography was performed. Occasionally, in cases where a lesion was at one level and could be clearly seen, we skipped discography. Also, disc herniation was excluded, and internal disc disruption was included in our study.

  • TELA and percutaneous endoscopic lumbar discectomy (PELD) are completely different. The main focus of PELD is the removal or decompression of the herniated disc. On the other hand, TELA refers to equipment that is used to perform an annuloplasty. A TELA working sheath cannot be inserted into the disc to observe its interior like an endoscope. The intradiscal procedure (granulation tissue removal) of TELA is performed under the C-arm. The PELD working sheath is placed half intradiscally and half epidurally. Both the intradiscal and extradiscal procedure are fully performed under endoscopic guidance. In addition, TELA uses a small working channel (outer diameter, 3.5 mm) compared with the PELD working sheath (more than 5 mm). Studies using percutaneous endoscopic annuloplasty (modified PELD) have been published [2,3]. This procedure is performed on the disc. A comparative study of the two procedure (TELA vs. PELD) is needed to examine complications, efficacy etc.

  • Normally, IDRA is performed under the C-arm. However, in our hospital, we have a LASE® kit (Clarus Medical LLC, Minneapolis, MN). So, we performed it under the C-arm and LASE® kit. Sometimes, we have used the epiduroscope.

  • The terminology is believed to require further discussion.

References

  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. Lee JH, Lee SH. Clinical efficacy and its prognostic factor of percutaneous endoscopic lumbar annuloplasty and nucleoplasty for the treatment of patients with discogenic low back pain. World Neurosurg 2017;105:832-40.
    Pubmed CrossRef
  3. Lee SH, Kang HS. Percutaneous endoscopic laser annuloplasty for discogenic low back pain. World Neurosurg 2010;73:198-206.
    Pubmed CrossRef