Yung Chen

Intradiscal Electrothermal Annuloplasty (IDET): A Novel Approach for Treating Chronic Discogenic Back Pain

Objective. This one‐year pilot outcome study was designed to investigate prospectively a series of patients with chronic discogenic back pain who underwent intradiscal electrothermal annuloplasty (IDET). Patients with chronic discogenic low back pain usually respond poorly to conservative medical care. Spinal fusion procedures have yielded mixed results. IDET is a new procedure to heat the intervertebral disc for the purpose of relieving discogenic pain. This study presents the one‐year results for the first 32 patients undergoing the IDET procedure. The objective of this article is to determine the safety and efficacy of the IDET procedure in patients with chronic discogenic back pain.

The Influence of Psychologic Factors on Diskography in Patients With Chronic Axial Low Back Pain

OBJECTIVE To determine whether a patients presenting psychometric scores affect the findings of a pressure and injection speed-controlled manometric lumbar diskography in patients with chronic low back pain (CLBP). DESIGN A prospective, correlation-based, investigative study. SETTING Free-standing ambulatory spine surgery center. PARTICIPANTS Two hundred sixty-three disks from 81 patients (54 men, 27 women). INTERVENTION Diskography was performed using pressure and injection speed-controlled techniques. The patients were divided into psychometric subgroups (normal, at risk, abnormal) according to the Distress and Risk Assessment Method (DRAM). MAIN OUTCOME MEASURES The diskography findings on each psychometric DRAM subgroup were evaluated. RESULTS Across the individual psychometric categories, the positive rates of diskography in the normal, at-risk, and abnormal subgroups were 75.0% (9/12), 59.5% (25/42), and 70.4% (19/27), respectively (P>.05). The mean numeric rating scores of pain at 15 and 50 psi above the opening pressure were similar in the 3 psychometric subgroups. There was no correlation between the diskography results and the psychometric subgroupings. CONCLUSIONS In patients with CLBP, there is no correlation between the presenting psychometric DRAM score and the findings from pressure and injection speed-controlled manometric lumbar diskography.

Percutaneous disc decompression in the management of chronic low back pain.

Although there has not yet been a percutaneous intradiscal procedure developed with the superior therapeutic efficacy of open surgery, these procedures are less invasive and avoid the complications of open surgery. All of these procedures have limitations, but their therapeutic effect increases substantially given careful patient selection and proper technique. New appliances and techniques to treat LBP or sciatica continue to evolve, and numerous controlled studies are underway. With tremendous technologic advances, use of minimally invasive techniques to treat chronic back pain continues to expand.

High thoracic spinal infection following upper gastrointestinal work-up

Spinal infections originating from the gastrointestinal tract are rare. We report a patient in whom esophageal rupture during endoscopy led to spinal infection with neurological deficit. An 80-year-old Asian man with a history of recent endoscopic gastrointestinal investigation presented to our clinic with the chief complaints of upper thoracic discomfort, chest pain and mild intermittent fever. Progressive weakness and numbness in both lower extremities had developed during the previous two weeks. A thoracic spine MRI showed a space-occupying lesion with involvement of the T2 and T3 vertebral bodies including an epidural abscess. After surgical decompression, the patient gradually recovered power in his lower extremities. Early diagnosis is a key factor to avoid neurologic sequelae in the treatment of patients with spinal infection. Physicians need to be aware of this potential complication following endoscopic gastrointestinal investigation.