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Int J Med Sci 2023; 20(8):1115-1122. doi:10.7150/ijms.85777 This issue Cite

Research Paper

An Analysis of the Clinical and Radiological Prognostic Factors Affecting the Outcomes of Lumbar Intradiscal Biacuplasty

Meng-Yin Yang, MD, PhD^1,2,3,4, Chin-Hwee Goh, MD⁵, Chin-Ying Wu, MD^6,7, You-Pen Chiu, MSc^8,9, Hui-Ru Ji, MSc^8,10, I-Han Hsiao, MD, PhD^8,11, Cheng-Di Chiu, MD, MBA, PhD^{2,8,9,10,11✉}

1. Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan.
2. Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.
3. College of Nursing, Central Taiwan University of Science and Technology, Taichung, Taiwan.
4. Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
5. Department of Neurosurgery, Sarawak General Hospial, Kuching, Sarawak, East Malaysia.
6. Department of Neurosurgery, China Medical University Hsinchu Hospital, Hsinchu, Taiwan.
7. Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan.
8. Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan.
9. Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan.
10. School of Medicine, China Medical University, Taichung, Taiwan.
11. Spine Center, China Medical University Hospital, Taichung, Taiwan.

✉ Corresponding author: Cheng-Di Chiu, MD, PhD Department of Neurosurgery, China Medical University & Hospital, Taichung, Taiwan. Address: No.2, Yu-Der Road, North Area, Taichung, Taiwan 40447, R.O.C. Telephone: +886-4- 22052121# 5034; +886-928829256; Fax: +886-4- 22053764; Email: cdchiu4046com; ORCID: 0000-0003-0369-0935. More

Abstract

Purpose: Intradiscal biacuplasty (IDB) has been proven to be effective for treating lumbar degenerative disc disease (DDD). However, there has not been a reported prognostic factor for IDB. The present study meticulously evaluates the general and radiographic features that may serve as markers for predicting the therapeutic outcome of IDB.

Methods: A prospective case series study was conducted, following time-series analysis moving averages models, with forty-one patients suffering from chronic discogenic lower back pain for more than six months. These patients subsequently received lumbar cool radiofrequency IDB and were enrolled in the study. Thirty-seven patients completed follow-up questionnaires at 1, 3, 6, and 12 months. The surgical outcomes were reported using visual analogue scale (VAS), Oswestry disability index (ODI), and the consumption of nonsteroidal anti-inflammatory drugs (NSAID). Furthermore, a univariate analysis was performed to identify prognostic factors associated with pain relief from age, gender, body mass index (BMI), and pre-operative lumbar magnetic resonance imaging reading.

Results: Significant reductions were found in estimated VAS and ODI at the post-operative period at 1, 3, 6, and 12 months (P < 0.001). The NSAID dosage was significantly decreased at 3-month and 1-year follow-up (P < 0.05). No procedure-related complications were detected. The prognosis of IDB was not related to disc height, Pfirrmann grading or Modic endplate change. However, disc extrusions were associated with promising outcomes (VAS improvement ≥ 50%) on pain relief (P < 0.05).

Conclusion: IDB is a good alternative choice for treating lumbar DDD. Patients with a painful extrusion lumbar disc may gain some benefits after receiving IDB following a period of failed conservative treatment. These findings may also add some references for physicians in the decision making when treating lumbar DDD.

Keywords: intradiscal biacuplasty, disc degenerative disease, herniated intervertebral disc, lumbar magnetic resonance imaging, prognostic factor

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