Timothy S. Eckel
Back pain is the most common pain complaint resulting in physician office visits. Most back pain resolves spontaneously with conservative treatment, although in some patients, pain persists, and the condition is termed chronic.1 The intervertebral disc has long been thought to be one source of chronic back pain, and in recent years the concept of a disco-genic pain source has become well accepted. Internal disc disruption is now thought to be causative in a large number, if not the majority, of instances of chronic low back pain.2-4 While some patients' symptoms and functional capacity will respond to aggressive conservative measures (rest, epidural steroids, physical therapy), these measures will fail in others. Surgical treatment for these patients, including interbody fusion techniques, has yielded mixed results in management of chronic pain and carries the risk of morbidity at surgery.5-10 In addition, inter-body fusion changes the mechanics of the weight-bearing spinal segment, concentrating stress at the levels above and below the fusion. The phenomenon of subsequent degeneration of adjacent spinal levels after interbody fusion is also well recognized. Given the mixed results and significant morbidity associated with surgery, there has been increased interest in developing minimally invasive therapies for the treatment of the painful disc. Chymopapain infusion,11 percutaneous disc decompression,12 percutaneous laser disc decompression,13 nucleoplasty, and other techniques have been developed for percutaneous disc decompression with dissolution or removal of portions of the nucleus pulpo-sus. Intradiscal electrothermal annuloplasty (IDEA), or intradiscal electrothermal therapy (IDET),3 is the first technique developed with the intent of directing minimally invasive therapy primarily to the posterior annulus of the disc to treat painful internal disc disruption.
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Tired Having Back Pains All The Time, But You Choose To Ignore It? Every year millions of people see their lives and favorite activities limited by back pain. They forego activities they once loved because of it and in some cases may not even be able to perform their job as well as they once could due to back pain.