New Thermal Annuloplasty treatment - Biacuplasty

[mmglobal]

I just spent over an hour on the phone with Dr. Whitworth. We discussed many things that I'll write about later, but one very interesting new technology is a new type of thermal annuloplasty called Biacuplasty. This is much different that other types of annuloplasty that I'm familiar with.

I've only seen IDET or SED being used by surgeons who use them as an adjunct to discectomy. It seems that proper candidates for thermal annuloplasty are a good candidate for discectomy. AND if they have discogenic low back pain, they'll also do the annuloplasty as well. Since I believe in the technology, I've been very frustrated when faced with clients who still have good disc height, are not too far down the degenerative cascade, have disabling low back pain, but don't have any of the normal indications for discectomy (large bulges, large tears, leg pain, disc protrusions, etc.. ) The doctors I know who do thermal annuloplasty will not consider just thermal annuloplasty without discectomy. IDET is kind of out. SED with TA is too invasive to consider on a disc that doesn't need a discectomy.

If this performs as intended, this new treatment (biacuplasty) will allow doctors to do more effective and more targeted thermal annuloplasty with an outpatient procedure that should not be more invasive or risky than discography or rhizotomy. Take a look at www.transdiscal.com. Doctor info / media has got some news items. Lots of interesting information there. Also, Bayliss Medical website has some info. (They also have a new system for SI joint procedures that Dr. W is interested in.)

There are a bunch of obvious questions about how they control the energy... what about disc bulges that may be near the cauda equina or exiting nerve roots... how to they manage the risk to the surrounging tissues, nerves, etc... I hope we find that all issues are adequately addressed and that this is a viable treatment for those with discogenic pain who are early enough in the process that they should be able to do something less invasive than ADR or even nucleus replacement.

Mark

From Science Daily:

Novel Radiofrequency Treatment Shows Promise For Lumbar Pain

Science Daily — Intradiscal biacuplasty is an effective procedure to treat chronic discogenic pain, report researchers at the 23rd annual meeting of the American Academy of Pain Medicine in New Orleans. Improvement in pain scores and functional capacity can be observed much earlier with intradiscal biacuplasty than with intradiscal electrothermal therapy suggesting some additional or/and different mechanisms of action. It also appears to be more effective than intradiscal electrothermal therapy producing more than 50% of the pain relief in more than 50% of patients.

Intradiscal electrothermal therapy has produced variable results in the pain reduction and functional improvement in patients with axial discogenic pain. A new procedure called intradiscal biacuplasty utilizes two radiofrequency electrodes placed on the opposite posterolateral sides of the treated annulus. This procedure is minimally invasive and provides an alternative to lumbar fusion or disc replacement surgery.

The researchers completed a pilot study of 13 patients who received intradiscal biacuplasty and were followed for six months. Following provocative discography patients underwent intradiscal biacuplasty. There were significant improvements of all of the indices (SF-36, Oswestry, Visual Analog Scale pain scores and opioid use) at the first follow-up at one month. Those improvements were maintained throughout six months of follow-up.

At six months after intradiscal biacuplasty, patient's median pain scores measured by Visual Analog Scale decreased from 7 to 3. Functional capacity significantly improved with Oswestry scores median decrease from 25 to 18, and SF-36 PF median increase from 55 to 70. Median SF-36 BP score increased from 35 to 58. Median opioid use expressed in morphine sulphate mg equivalents decreased from 40 to 5 mg. There were no significant differences in any of the indices from first to sixth month after intradiscal biacuplasty. There were eight of 13 patients who had Visual Analog Scale pain scores decreased by three or more points. There were no complications perioperatively or during follow-up.

Investigators: Leonardo Kapural, MD, PhD, Alan Ng, MD, and Nagy Mekhail, MD, PhD., from Cleveland Clinic Foundation, Cleveland, OH.

[paindoc]

Mark,
Just be careful when evaluating these "new" thermogenic procedures. I trained at Texas Tech' s interventional program with Gabor Racz and Prithvi Raj so we were constantly being asked to evalualte and study these new technologies. By the time I had arrived, Racz and Raj had pretty much thrown IDET's under the bus and felt they really didn't work very well. It seems the dehyration of the nuclear/ annular junction that occurs with these procedures can actually increase the size of a fracture rather than seal it,and there were othe disc decompressions systems that they felt were far superior. Then along came Disctrode. The theory was great, place the catheter in the annulus itself rather than annular/nuclear junction. We spent a year doing this (only Dr. Racz was allowed for study purposes), and we could only get one pt. better....just one! And I wound up having to present and defend the case at a national meeting...not an enviable task when you don't believe in the technology. All I'm saying is that what sounds good in theory doesn't always translate to the real world, and we've been beating this thermal annuloplasty idea like a dead horse with very limited success.

[no34evr]

I know this is an old post but I still wanted to reply because I had this procedure done to my L3-4 disc last Sep 07 and it was a success! I had to wear a tortoise shell type brace during the day for 6 weeks and and soft one at night and then the soft one for a couple of weeks after that and that was it. I still had some soreness for a couple of months but it cleared up completely.

Just thought I put that out there in case anyone was interested. I did have a grade 4 annuluar tear prior to the procedure. Sure beats getting it fused!

Cathy

[Maria]

Cathy,
congrats on your success w/this procedure/surgery. Bringing the topic back to life makes me want to read about it a bit more so glad you posted your outcome!

Also thanks Paindoc for your input/insight.