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Original Article

Korean J Pain 2019; 32(2): 113-119

Published online April 1, 2019 https://doi.org/10.3344/kjp.2019.32.2.113

Copyright © The Korean Pain Society.

Efficacy of transforaminal laser annuloplasty versus intradiscal radiofrequency annuloplasty for discogenic low back pain

Chan Hong Park1 , Kyoung Kyu Lee2, and Sang Ho Lee3

1Department of Anesthesiology and Pain Medicine, Daegu Wooridul Spine Hospital, Daegu,
2Department of Neurosurgery, Daegu Woridul Spine Hospital, Daegu,
3Department of Neurosurgery, Chungdam Wooridul Spine Hospital, Seoul, 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: +82-53-212-3049, E-mail: magary1@hanmail.net
ORCID: https://orcid.org/0000-0002-1305-0395

Received: November 15, 2018; Revised: January 8, 2019; Accepted: January 15, 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.

Abstract

Background

Discogenic pain is a common cause of disability and is assumed to be a major cause of nonspecific low back pain. Various treatment methods have been used for the treatment of discogenic pain. This study was conducted to compare the therapeutic success of radiofrequency (an intradiscal procedure) and laser annuloplasty (both an intradiscal and extradiscal procedure).

Methods

This single-center study included 80 patients and followed them for 6 months. Transforaminal laser annuloplasty (TFLA, 37 patients) or intradiscal radiofrequency annuloplasty (IDRA, 43 patients) was performed. The main outcomes included pain scores, determined by the numeric rating scale (NRS), and Oswestry disability index (ODI), at pre-treatment and at post-treatment months 1 and 6.

Results

The patients were grouped according to procedure. In all procedures, NRS and ODI scores were significantly decreased over time. Mean post-treatment pain scores at months 1 and 6 were significantly lower (P < 0.01) in both groups, and between-group differences were not significant. The ODI score was also significantly decreased compared with baseline. Among patients undergoing TFLA, 70.3% (n = 26) reported pain relief (NRS scores < 50% of baseline) at post-treatment 6 months, vs. 58.1% (n = 25) of those undergoing IDRA. There were no statistically significant differences between the groups in ODI reduction of > 40%.

Conclusions

Our results indicate that annuloplasty is a reasonable treatment option for carefully selected patients with lower back and radicular pain of discogenic origin, and TFLA might be superior to IDRA in patients with discogenic low back pain.

Keywords: Annulus fibrosus, Case-control studies, Clinical trials, Disability evaluation, Intervertebral disc, Lasers, Low back pain, Pain management, Pain measurement, Radiofrequency ablation