April 16, 2013

Treatment of low back pain from the disc

Our second blog is on Intradiscal procedures. There are many structures in the back which can cause pain, including the facets, the sacroiliac joint and the discs. There are many ways the disc can cause problems, for example a disc protrusion (also called a herniated disc or herniated nucleus pulposus). Herniated discs cause pain by compressing the nerve root, with pain in the area where the nerve goes.
We are interested today in a different type of disc problem, where the disc itself is the source of the pain. The disc has two parts, the annulus, which is the tough outer part, like a tire, that holds in the second part, the inner nucleus. The nucleus is the jelly-like part that supports the weight of the body. The annulus can get a tear in it. That tear can cause pain because of nerve growth into the tear and changes which make that nerve hurt.
Pain coming from the disc can hurt enough that it can interfere with your life. Why not treat it with surgery? The simple answer is that, unless the joint is unstable, fusion does not work well. I just don’t like it when patients tell me the last day they worked was the day before their fusion.
The first step to treat is to diagnose. The way we diagnose disc disease is with provocation discography. I put a needle in the disc and inject dye. All the while, we are chatting about whatever we are chatting about, baseball, barbeque, grandkids, whatever. If I pressurize a non-painful disc, our conversation continues. If I pressurize a painful disc, the conversation stops immediately. Discography is an important tool to diagnose disc disease. Something called receiver operator characteristic curves have been used to increase the accuracy of discography. Unfortunately, the technique has been highly criticized and many insurers will not pay for it.
The best technology we have currently to treat Intradiscal disorder is heat, using the Biacuplasty procedure. Biacuplasty passes heat through the annulus. The heat destroys those unwanted nerves in the annulus, causing you to feel better. About 50% of people get 50% relief. If you don’t get relief, then you are no worse off. The only exception is that if some very rare complication occurs, just as if your car was t-boned by someone running a red light which you are driving home from the office. So, Biacuplasty is an important, effective procedure which offers relief when there is no other treatment.
Medicare has decided that they are not covering Intradiscal procedures, such as Biacuplasty. To treat Intradiscal procedures, you have to have a reasonably healthy disc. If you have lost an inch in height because your discs have dried up and shrunk, an Intradiscal procedure is unlikely to help. However, for younger patients, generally younger than the early 60s, Biacuplasty is a very important treatment.
I provide this service on a cash basis.
The future will be in injecting things into the disc to rejuvenate the disc. Work on these injections is being done in places like Brazil and China. We will bring them to the US as they become available.
If you have on-going low back pain, contact us to find out whether you are a candidate for treatment of an Intradiscal disorder.