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Percutaneous Disc Decompression Catheter
Low Back Pain: On the Cut-Less Edge

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Percutaneous Disc Decompression Catheter
A preliminary report using the BBHI-2 as an outcome tool.

J Brendel MD, Daniel Bruns PsyD, J Mark Disorbio EdD

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.