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Risk Factors for Failure and Complications of Intradiscal Electrothermal Therapy: A Pilot Study

Cohen, Steven P., MD*; Larkin, Thomas, MD*; Abdi, Salahadin, MD, PhD; Chang, Audrey, PhD; Stojanovic, Milan, MD

doi: 10.1097/01.BRS.0000067269.31377.6A
Clinical Case Series

Study Design. A bi-institutional, retrospective clinical data analysis.

Objectives. To determine risk factors for failure and complications of intradiscal electrothermal therapy, a treatment for discogenic back pain.

Summary of the Background Data. Intradiscal electrothermal therapy is a relatively new treatment for discogenic back pain. Though previous studies have shown it to be an effective treatment, there are few published studies examining complications and none examining risk factors for failure.

Methods. The authors treated 79 patients with discogenic back pain using intradiscal electrothermal therapy. Complications were assessed by patient report and, when indicated, further diagnostic testing. Success or failure was determined by visual analogue pain scores at 6-month follow-up. Variables examined for their relationship to failure and complications were age, sex, duration of pain, number of levels heated, smoking history, diabetes, obesity, leg pain, and previous back surgery.

Results. Forty-eight percent of patients reported more than 50% pain relief at their 6-month follow-up. There were eight complications (10%), most of which were self-limited and transient. The only risk factor associated with intradiscal electrothermal therapy failure was obesity (P = 0.01). Whereas 54% of nonobese patients reported good pain relief at 6 months, only one out of 10 obese patients had successful intradiscal electrothermal therapy. The obese patients in our study were more likely to have a complication from intradiscal electrothermal therapy than they were to obtain pain relief.

Conclusion. The only risk factor found to be associated with IDET outcome was obesity, which was a strong predictor of failure. Obesity should be considered a relative contraindication to performing IDET.

From the *Pain Management Center, Department of Anesthesia, Walter Reed Army Medical Center, Washington, DC, and the Uniformed Services University of the Health Sciences, Bethesda, Maryland;

†Department of Clinical Investigation, Walter Reed Army Medical Center, Washington, DC; and

‡MGH Pain Center, Department of Anesthesia and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

Acknowledgement date: April 16, 2002.

First revision date: July 26, 2002.

Acceptance date: October 15, 2002.

The submitted manuscript does not contain information about medical devices or drugs.

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence to Steven P. Cohen, MD, NYU School of Medicine, Department of Anesthesiology, 550 First Avenue, New York, NY 10016, USA; E-mail:

© 2003 Lippincott Williams & Wilkins, Inc.