Study Design: Prospective longitudinal study with a 2-year follow-up.

Background: Intradiscal electrothermal therapy (IDET) was introduced to bridge the gap between conservative measures (analgesia, physiotherapy and standard injection therapy) and radical surgery (disc replacement and fusion) for the treatment of internal disc disruption (IDD). Recent reports have questioned the efficacy and safety of this so called less invasive treatment technology.

Objective: To assess the long-term outcome of patients with chronic discogenic low back pain (< 6 months duration) treated with IDET who had previously failed to improve with comprehensive nonoperative treatment.

Methods: Forty patients with IDD determined by provocative discography and pre-operative MRI were treated with IDET. VAS pain scores, SF-36 scores, analgesic usage and sitting tolerance times (mins) were collected pre-treatment and at 12 and 24 months. Subsequent treatments were recorded. Statistical analysis was performed using Wilcoxon signed rank tests to test for differences in the outcome parameter scores.

Results: Average age was 46 years (range 25–62 years) with 44% males and 56% females. The study group demonstrated no significant improvement in pain intensity as measured by VAS and bodily pain SF-36 scores pre treatment and at 12 and 24 months post IDET. There were no significant differences in the remaining SF-36 subscale scores at 0, 12 and 24 months after treatment. Analgesia requirement remained the same in 77% of the patients; 12% required stronger analgesia and only 11% used less pain medication. Although sitting tolerance improved between pre and 1-year post IDET, the difference was not significant. Eight (20%) patients underwent further surgery in the form of a disc replacement or fusion at 1-year post treatment.

Conclusion: The patients with chronic discogenic low back pain in this study did not show any improvement at 1-year or 2-year post IDET treatment. A significant proportion of patients underwent further surgery for persisting low back pain. We believe that the efficacy of IDET in the treatment of chronic discogenic low back pain is doubtful.

We describe two patients with claw hand as a result of a bee sting. It is likely that this was caused by the apamin in the sting which has an effect on the upper limb, at the spinal cord and on the peripheral nerves. It is important to recognise that the claw hand is not owing to compartment syndrome. Both patients were treated conservatively with full resolution within 48 hours, without any lasting effects.