Twelve-month follow-up of a controlled trial of intradiscal thermal anuloplasty for back pain due to internal disc disruption

Study Design. Case-control study. Objectives. To determine the prima facie efficacy of intradiscal electrothe rmal anuloplasty (IDTA). Summary of Background Data. Although it is being used increasingly as a put ative treatment for internal disc disruption, no studies have been publishe d on the efficacy of IDTA. Methods. Fifty-three patients with back pain determined by computed tomogra phic (CT)-discography to be due to internal disc disruption were offered tr eatment. The outcomes of 35 patients treated with IDTA were compared with t hose of a convenience sample of 17 patients treated with a physical rehabil itation program, by using a visual analog pain scale, use of analgesics, an d return to work as measures. Results. At 3 months, only one control patient obtained any significant deg ree of relief of pain, compared with 23 in the index group. Relief of pain was sustained at 6 and 12 months and was associated with improvement in dis ability, reduced drug use, and a return to work rate of 53%. Depending on t he stringency of criteria used, the success rate of IDTA may be as low as 2 3% or as high as 60% with confidence intervals of +/-16%. Conclusions. In carefully selected cases, IDTA can eliminate or dramaticall y reduce the pain of internal disc disruption in a substantial proportion o f patients and appears to be superior to conventional conservative care for internal disc disruption.