Intradiscal therapy: a review of current treatment modalities.

STUDY DESIGN: A systematic review of the medical literature regarding current intradiscal therapeutic methods.

OBJECTIVES: To establish an understanding of the current intradiscal treatment options for the management of low back pain.

SUMMARY OF BACKGROUND DATA: Current treatment of intradiscal disease is rapidly evolving and as such should be a multidisciplinary effort that follows a logical, orderly algorithm. Minimally invasive techniques, namely, intradiscal electrothermal therapy (IDET), radiofrequency ablation (RFA), percutaneous endoscopic laser discectomy (PELD), and cryoablation have challenged the conventional surgical management of back pain.

METHODS: Thirty-eight research reports, published between 1986 and 2005, were systematically reviewed for disease classification, surgical intervention, and treatment outcomes (neurologic status, pain scores, and ambulation).

RESULTS: The surgical literature on the management of intradiscal disease continues to be limited to large series with short clinical follow-ups. Arthrodesis continues to be the primary treatment modality in the majority of patients. Newer treatment options including IDET, RFA, PELD, and cryoablation have shown promising results with regards to symptomatic relief and early return to function.

CONCLUSION: Low back pain is an extremely common and potentially debilitating problem. Adding biophysical methods to well-tested biomechanical and newly investigated biomolecular solutions allows for multiple avenues of therapeutic interventions. With future clinical and basic science studies regarding intradiscal therapies forthcoming, we may soon alter our current treatment algorithms for the management of discogenic back pain.