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Percutaneous
Disc Decompression Catheter
A preliminary report using the BBHI-2 as an outcome
tool.
Introduction: Contained
disc protrusions causing radicular or referred
leg pain and axial back pain encompass a large
percentage of patients seeking medical attention.
No data exists regarding the prevalence of back
pain with radicular or referred pain, or for the
effectiveness of the Viking catheter for this
indication. The following is preliminary study
utilizing this technology and the BBHI-2 to assess
outcomes.
Methods: Patient
selection: patients with contained pericentral
or central disc protrusions whom failed medical
management, a formal core stabilization program,
and TF ESI's were included. Typical criteria such
as maintained disc height > 50% of normal,
and "typical" IDET inclusion criteria
were utilized. All patients agreed to a pre-op
BBHI-2 psychological evaluation and a follow-up
BBHI 2 at 2 weeks, and at 2 or more months post
procedure. One practitioner was utilized for consistency.
That physician was blinded to the BBHI-2 outcomes
during the treatment, and follow-up evaluations.
No financial support was obtained from Smith Nephew
or Pearson Assessments for this study.
The low back norms were based on
a national sample of 270 patients in treatment
for low back injury. This sample excluded any
patients who were also in treatment for lower
extremity injuries.
The standard heating protocol for the Viking catheter
(12 minutes) was utilized. Some patients did not
obtain a final temp of 90 degrees Centigrade due
to discomfort. No patients received epidural medication
during or after the procedure. Intradiscal ancef
was given at the completion of the heating protocol.
All patients wore a corset for one-week post op.
Results: At intake,
18 patients were assessed with the BBHI 2, of
which 15 were reassessed at the first follow-up
(about two weeks), and 7 at the second follow-up
(median time four months). In both the first and
second follow-ups, patients reported significantly
lower levels of low back pain (p = .0045), lower
extremity pain (p = .0023), lowest pain (p = .012)
and peak pain (p = .0017), with mid back pain
(p = .0096) showing improvement at the first follow-up.
Patients also reported a greater ability to tolerate
the residual pain (p = .014), which was rated
as being significantly less disabling. Additionally,
patients reported lower level of stress symptoms
(p = .0034), and a higher level of functioning
(p = .011) at both follow-ups, and an improved
quality of life at second follow up (p = .018).
The mean rates of pain for the 270 patients with
low back injuries on the BBHI-2 were as follows:
thoracic pain (3.8), lumbar pain (6.5), genital
pain (0.85), abdominal pain (1.7), and lower extremity
pain (3.7). Overall, 194 of the patients (72%)
reported some lower extremity pain, with 86 of
the patients (32%) reporting lower extremity pain
that was greater than or equal to the lumbar pain.
In 35 of these cases (13%), the lower extremity
radicular pain actually exceeded the back injury
pain.
Discussion: Lower
extremity pain is common among patients with low
back injuries. Patients in this study with central
and pericentral contained disc protrusions and
low back pain with either referred or radicular
pain benefited from percutaneous disc decompression,
showing significant improvement in pain, functioning
and stress symptoms. As the BBHI-2 is a measuring
device with established validity and reliability,
this strengthens these findings.
The BBHI-2 is a test commonly utilized
in the psychological assessment of pain patients.
In this study it was utilized as a valuable outcome
tool to assess positive improvements in patient
pain scores, function, somatic complaints and
pain tolerance.
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