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Voir également :Classification des lésions discales lombaires (Pr J.Y. Maigne)

Revolutionary Treatment for Chronic Back Pain
SOURCE Meadowlands Hospital Medical Center

Two Meadowlands Hospital Medical Center physicians have introduced the revolutionary new Intradiscal Electrothermal Annuloplasty procedure, also known as (IDET) to the New York metropolitan area.
Sri Kantha, M.D. and Ari Ben-Yishay, M.D. have been performing this procedure at Meadowlands Hospital for the past several months, treating 12 patients suffering from severe low back pain and successfully achieving pain relief.
Dr. Kantha, a Pain Management expert and Medical Director of the Meadowlands Pain Management Center and Dr. Ben-Yishay, a noted spine surgeon, have pioneered this procedure in the New York metropolitan area. Currently, Meadowlands Pain Management Center is the only facility offering this procedure for the relief of back pain in this area.

The procedure, which was developed in California by Stanford spine specialist Dr. Jeffery Saal and his brother, Dr. Joel Saal, was publicized in Newsweek, March 15, 1999 and was recently profiled on NBC's "Dateline."
This procedure consists of inserting a special catheter with a heating element at the tip introduced through a six-inch long needle in to the patient's disc area. The needle is inserted through the skin without any open surgery. The heating element is connected to a machine that generates electrothermal heat up to 194 degrees F for a total of 15 minutes. The heat deadens the painful area of the disc and also helps to harden the affected disc, thus alleviating the pain.

The IDET procedure is an alternative to a lumbar fusion and is done under local anesthesia and takes approximately 30 minutes compared to fusion which could take up to several hours and is performed under general anesthesia with recuperation of several days to months. The recuperation from IDET is a few days with necessary precautions taken to avoid lumbar sprain. For information on this and other Pain Management procedures contact Sri Kantha, M.D. at 201-392-3585.

Richard Derby MD - Bjorn Eek MD - Deaglán P. Ryan MS
Introduction: Intradiscal Electrothermal Annuloplasty (IEA or IDET) is a relatively new procedure to heat the intervertebral disc for the purpose of relieving discogenic pain. This abstract represents the six-month follow-up of the first 20 patients enrolled into an ongoing pilot study, whose purpose is to investigate the long-term efficacy of the IEA procedure.

Methods and Materials:
The IEA procedure utilizes an Oratec Interventions 30cm SPINECath1 catheter, with a 6cm active tip. Utilizing normal discographic technique, the catheter is inserted anteriorly into the annulus or nucleus via a 17-gauge introducer. The active tip is typically advanced anterior-laterally inside the nuclear tissue, and is directed circuitously to return posteriorally, ideally achieving full 360° penetration. (Fig. 1) Following catheter positioning, electrothermal heat is generated at the active tip, commencing at 65°C and increasing incrementally to (typically) 80°C, for a mean duration of 14 minutes.

From 5/97 to 11/97 we enrolled our first twenty consecutive patients undergoing the IEA procedure into a prospective outcome study. Strict inclusion and exclusion criteria were adhered to. Prior to IEA all patients underwent pressure-controlled discography to determine the number of symptomatic discs, the location of annular tears, and to categorize the sensitivity of the disc annulus to pressurization.

Outcome at 6 months was assessed by examining changes between the baseline questionnaire (administered to each patient just prior to their undergoing the IEA procedure) and a six month follow-up questionnaire. Two primary comparative outcome instruments were utilized. A mean 2 point decrease on a 10-point visual analogue pain scale was found (p<.05). An analysis of the 24-point Roland & Morris Disability questionnaire returned a mean 2.2 point decrease in disability, which was found to be non-significant.
At follow-up, patients' satisfaction with the procedure and its outcome were examined on a modified 4-point NASS Patient Satisfaction Index. 73% of the sample were satisfied with their outcome, reporting that they would repeat the procedure for the same outcome. 27% felt themselves to be the same or worse than before undergoing the IEA procedure. At follow-up, five subjective improvement-in-activity variables were also examined. 53% of the sample reported an improvement in general overall activity levels, 73% in sitting, 47% in standing, 46% in walking and 40% reported an improvement in their sleeping.

In the early stages of investigation, intradiscal electrothermal annuloplasty appears promising as a technique to reduce chronic pain of discogenic origin. Further study is warranted, both to compare efficacy against other intradiscal heating procedures and to assess the precise pathology most successfully treated by the procedure. The current study is ongoing, and the 12-month follow-up results will be presented as time allows.

Fig 1: Typical catheter placement

1 The SPINECath catheter is manufactured & distributed by Oratec Interventions. Physicians requiring further information on equipment or procedure may contact Oratec Interventions at 3700 Haven Court, Menlo Park, CA 94025. (Tel (650) 369-9904) Please note, none of the authors hold any interest in this company.
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