Abstract
Introduction: Biacuplasty is an innovative intervention for the treatment of discogenic pain. It involves inserting electrodes bilaterally into the posterolateral corner of the anulus fibrosus. Radiofrequency current is passed between the electrodes, but each electrode is water-cooled. This prevents coagulation occurring around the surface of the electrode, which allows a three-dimensional lesion to develop between the electrodes. Theoretically this lesion would seal radial and circumferential fissures, and coagulate nerve endings throughout the posterior anulus.
Methods: As part of a multi-centre, limited release of biacuplasty, a prospective audit of outcomes was undertaken in 8 patients with chronic low back pain, in whom discography reproduced their pain and post-discography CT demonstrated a radial fissure. They were 6 men and 2 women, aged between 34 and 58 years, who had back pain for longer than 4 years. Four were still working but four were on workers compensation. At the time of writing, all patients had completed clinical assessments before treatment and at one, two, three, and six months after treatment, using a visual analogue scale for pain, and the Oswestry Disability Questionnaire (ODQ) and the SF36 for disability and function.
Results: Performed under local anaesthesia, the procedure was painless, and took less than one hour to complete. No complications occurred, and no patient suffered any side-effects. Group pain scores (median; interquartile range) at inception (69; 53–78) improved significantly at one month (35; 11–65) (p = 0.05); deteriorated by three months (41; 14–72) (p = 0.14); but were stable at 6 motns (40; 22–69). Scores for disability (54; 42–67) and physical functioning (33; 13–48) improved (to 50; 29–62 and 50; 20–59, respectively) but did not achieve statistical significance. In categorical terms, however, four patients obtained no benefit, one patient obtained partial, but worthwhile, reduction in pain, but three patients achieved greater than 50% relief of pain at three months, and four did so at 6 months. Reduction in pain was corroborated by a decrease in disability on the ODQ by 11 (5,2) points at three months, and 10 (−4, 15) points at 6 months; and increases in physical functioning on the SF36 by 15 (6,2) points at three months, and 5 (2,2) points at six months.
Discussion: These results in Australian patients echo those reported in one of the US arms of the study, in which 8 of 13 patients reduced their pain scores by at least 30 points. Attractive about this new procedure was its ease of execution and painlessness. Although the success rate is modest, this procedure could emerge as an entertainable option for the management of discogenic pain, if its effectiveness can be corroborated in a larger sample and for a longer time.
Correspondence should be addressed to Dr Owen Williamson, Editorial Secretary, Spine Society of Australia, 25 Erin Street, Richmond, Victoria 3121, Australia.
