Percutaneous thermocoagulation intradiscal techniques for discogenic low back pain

Study Design. Systematic review. Objective. To systematically review the evidence on the efficacy, effectiveness, and safety of percutaneous thermocoagulation intradiscal techniques for discogenic low back pain. Summary of Background Data. The intervertebral disc is thought to be the source of pain in a relevant proportion of cases of low back pain (LBP). Two percutaneous thermocoagulation intradiscal techniques have been described to treat discogenic LBP: percutaneous intradiscal radiofrequency thermocoagulation (PIRFT) and intradiscal electrothermal therapy (IDET). Methods. An electronic search was performed in MEDLINE, EMBASE, and the Cochrane Library databases up to 2005, to identify nonrandomized controlled trials and randomized controlled trials (RCTs) on those techniques. All relevant studies were methodologically assessed independently by 3 reviewers. RCTs were assessed following the criteria recommended by the Cochrane Back Review Group. A qualitative synthesis of results was performed. Results. Six studies were included with a total of 283 patients. Two open, nonrandomized trials ( 95 patients) showed positive results for IDET compared with rehabilitation and PIRFT. Results from 2 RCTs showed no differences between PIRFT and placebo, and between different PIRFT techniques. Two RCTs compared IDET with placebo. One suggested differences only in pain and in disability, while the best quality RCT showed no differences. Conclusions. The available evidence does not support the efficacy or effectiveness of percutaneous thermocoagulation intradiscal techniques for the treatment of discogenic low back pain.