• intervertebral disc degeneration
• low back pain
• outcome assessment
• percutaneous intradiscal procedure
• predictive value

• Humans
• Female
• Male
• Retrospective Studies
• Low Back Pain/therapy
• Middle Aged
• Adult
• Lumbar Vertebrae/surgery
• Treatment Outcome
• Diskectomy, Percutaneous/methods
• Intervertebral Disc Displacement/complications
• Intervertebral Disc Displacement/therapy
• Intervertebral Disc Displacement/surgery
• Pain Measurement
• Intervertebral Disc Degeneration/complications
• Intervertebral Disc Degeneration/therapy
• Intervertebral Disc Degeneration/surgery

The intervertebral disc (IVD) is the fibrocartilaginous joint located between each vertebral body that confers flexibility and weight bearing capabilities to the spine. The IVD plays an important role in absorbing shock and stress applied to the spine, which helps to protect not only the vertebral bones, but also the brain and the rest of the central nervous system. Degeneration of the IVD is correlated with back pain, which can be debilitating and severely affects quality of life. Indeed, back pain results in substantial socioeconomic losses and healthcare costs globally each year, with about 85% of the world population experiencing back pain at some point in their lifetimes. Currently, therapeutic strategies for treating IVD degeneration are limited, and as such, there is great interest in advancing treatments for back pain. Ideally, treatments for back pain would restore native structure and thereby function to the degenerated IVD. However, the complex developmental origin and tissue composition of the IVD along with the avascular nature of the mature disc makes regeneration of the IVD a uniquely challenging task. Investigators across the field of IVD research have been working to elucidate the mechanisms behind the formation of this multifaceted structure, which may identify new therapeutic targets and inform development of novel regenerative strategies. This review summarizes current knowledge base on IVD development, degeneration, and regenerative strategies taken from traditional genetic approaches and omics studies and discusses the future landscape of investigations in IVD research and advancement of clinical therapies.

• back pain
• orthobiologics
• plasma rich in growth factors (PRGF)
• platelet rich plasma (PRP)
• regenerative medicine
• spinal pain

• Adolescent idiopathic scoliosis (AIS)
• Anterior vertebral body tethering (AVBT)
• Humanitarian device exemption (HDE)
• Posterior spinal fusion (PSF)
• Spine deformity
• Vertebral body tethering (VBT)

Lower back pain is considered to be one of the most common complaints that brings a patient to a pain specialist. Several modalities in interventional pain management are known to be helpful to a patient with chronic low back pain. Proper diagnosis is required for appropriate intervention to provide optimal benefits. From simple trigger point injections for muscular pain to a highly complex intervention such as a spinal cord stimulator are very effective if chosen properly. The aim of this article is to provide the reader with a comprehensive reading for treatment of lower back pain using interventional modalities.

Extensive search for published literature was carried out online using PubMed, Cochrane database and Embase for the material used in this manuscript. This article describes the most common modalities available to an interventional pain physician along with the most relevant current and past references for the treatment of lower back pain. All the graphics and images were prepared by and belong to the author.

This review article describes the most common modalities available to an interventional pain physician along with the most relevant current and past references for the treatment of lower back pain. All the graphics and images belong to the author. Although it is beyond the scope of this review article to include a very detailed description of each procedure along with complete references, a sincere attempt has been made to comprehensively cover this very complex and perplexing topic.

Lower back pain is a major healthcare issue and this review article will help educate the pain practitioners about the current evidence based treatment options.

• Decompression
• Discography
• Facet Joint
• Interventional Therapies
• Intradiscal Procedures, Disc
• Low Back Pain
• Procedures
• Sacroiliac joint
• Spinal Cord Stimulation

• Humans
• Minimally Invasive Surgical Procedures/methods
• Minimally Invasive Surgical Procedures/trends
• Spine/surgery

• annulus fibrosus
• biomaterials
• intervertebral disc
• low back pain
• review
• spine
• tissue engineering

• Biocompatible Materials
• Humans
• Intervertebral Disc/anatomy & histology
• Intervertebral Disc/pathology
• Intervertebral Disc Degeneration/physiopathology
• Intervertebral Disc Degeneration/surgery
• Low Back Pain/surgery
• Tissue Engineering

• Classification
• Degeneration
• Diagnosis
• Discogenic low back pain
• Internal annular disruption
• Internal disc disruption
• Internal endplate disruption
• Intervertebral disc
• Treatment

We have developed an intradiscal pulsed radiofrequency (Disc PRF) technique, using Diskit II® needles (NeuroTherm, Wilmington, MA, USA), as a minimally invasive treatment option for chronic discogenic low back pain (LBP). The purpose of this study was to compare the representative outcomes of Disc PRF and Intradiscal Electrothermal Therapy (IDET) in terms of pain relief and reduction of disability.

Thirty-one patients with chronic discogenic LBP who underwent either Disc PRF (n = 15) or IDET (n = 16) were enrolled in the study. A Diskit II® needle (15-cm length, 20-gauge needle with a 20-mm active tip) was placed centrally in the disc. PRF was applied for 15 min at a setting of 5 × 50 ms/s and 60 V. The pain intensity score on a 0-10 numeric rating scale (NRS) and the Roland-Morris Disability Questionnaire (RMDQ) were assessed pretreatment and at 1, 3, and 6 months post-treatment.

The mean NRS was significantly improved from 7.2 ± 0.6 pretreatment to 2.5 ± 0.9 in the Disc PRF group, and from 7.5 ± 1.0 to 1.7 ± 1.5 in the IDET group, at the 6-month follow-up. The mean RMDQ also showed significant improvement in both the Disc PRF group and the IDET group at the 6-month follow-up. There were no significant differences in the pretreatment NRS and RMDQ scores between the groups.

Disc PRF appears to be an alternative to IDET as a safe, minimally invasive treatment option for patients with chronic discogenic LBP.

• Intradiscal Electrothermal Therapy
• intervertebral disc degeneration
• low back pain
• pulsed radiofrequency treatment

• cool radiofrequency
• discogenic pain
• intradiscal electrothermal therapy
• low back pain
• transdiscal biacuplasty

• Adult
• Chronic Disease
• Enzyme Inhibitors/administration & dosage
• Female
• Humans
• Injections, Spinal
• Intervertebral Disc Displacement/complications
• Intervertebral Disc Displacement/diagnosis
• Intervertebral Disc Displacement/drug therapy
• Low Back Pain/diagnosis
• Low Back Pain/drug therapy
• Low Back Pain/etiology
• Male
• Methylene Blue/administration & dosage
• Pain Measurement/drug effects
• Placebo Effect
• Treatment Outcome

• Adult
• Analysis of Variance
• Double-Blind Method
• Electric Stimulation Therapy/methods
• Female
• Follow-Up Studies
• Humans
• Hyperthermia, Induced/methods
• Intervertebral Disc Displacement/complications
• Intervertebral Disc Displacement/therapy
• Low Back Pain/etiology
• Low Back Pain/psychology
• Low Back Pain/therapy
• Lumbar Vertebrae/physiology
• Male
• Middle Aged
• Pain Measurement/methods
• Quality of Life
• Recovery of Function
• Retrospective Studies
• Severity of Illness Index
• Time Factors
• Treatment Outcome

Falls are the sixth leading cause of death in elderly people in the U.S. Despite progress in understanding risk factors for falls, many suspected risk factors have not been adequately studied. Putative risk factors for falls such as pain, reductions in cerebral blood flow, somatosensory deficits, and foot disorders are poorly understood, in part because they pose measurement challenges, particularly for large observational studies.

The MOBILIZE Boston Study (MBS), an NIA-funded Program Project, is a prospective cohort study of a unique set of risk factors for falls in seniors in the Boston area. Using a door-to-door population-based recruitment, we have enrolled 765 persons aged 70 and older. The baseline assessment was conducted in 2 segments: a 3-hour home interview followed within 4 weeks by a 3-hour clinic examination. Measures included pain, cerebral hemodynamics, and foot disorders as well as established fall risk factors. For the falls follow-up, participants return fall calendar postcards to the research center at the end of each month. Reports of falls are followed-up with a telephone interview to assess circumstances and consequences of each fall. A second assessment is performed 18 months following baseline.

Of the 2382 who met all eligibility criteria at the door, 1616 (67.8%) agreed to participate and were referred to the research center for further screening. The primary reason for ineligibility was inability to communicate in English. Results from the first 600 participants showed that participants are largely representative of seniors in the Boston area in terms of age, sex, race and Hispanic ethnicity. The average age of study participants was 77.9 years (s.d. 5.5) and nearly two-thirds were women. The study cohort was 78% white and 17% black. Many participants (39%) reported having fallen at least once in the year before baseline.

Our results demonstrate the feasibility of conducting comprehensive assessments, including rigorous physiologic measurements, in a diverse population of older adults to study non-traditional risk factors for falls and disability. The MBS will provide an important new data resource for examining novel risk factors for falls and mobility problems in the older population.

• internet
• ambulatory care
• pain
• screening
• mobility

• Chronic Disease
• Electrosurgery
• Evidence-Based Medicine
• Humans
• Hyperthermia, Induced
• Intervertebral Disc/surgery
• Intervertebral Disc Displacement/surgery
• Intervertebral Disc Displacement/therapy
• Low Back Pain/surgery
• Low Back Pain/therapy

Endoscopic spine surgery has evolved gradually through improvements in endoscope design, instrumentation, and surgical techniques. The ability to visualize and treat painful pathology endoscopically through the foramen has opened the door for the diagnosis and treatment of degenerative conditions of the lumbar spine (from T10 to S1). Other endoscopic techniques for treating a painful disc have been focused on a posterior approach and has been compared with micro–lumbar discectomy. These procedures have not been more effective than open microdiscectomy but are less invasive, have less surgical morbidity, and allow for more rapid surgical recovery. Spinal decompression and fusion was the fallback procedure when nonsurgical treatment or discectomy failed to relieve sciatica and back pain. Foraminal endoscopic surgery, however, provides a truly minimally invasive alternative approach to the pathoanatomy of the lumbar spine because it preserves the multifidus muscle, maintains motion, and eliminates or, at worst, delays the need for fusion.

The following developments helped facilitate the evolution of a transforaminal endoscopic surgery procedure for disc herniations from a foraminal disc decompression, also known as percutaneous endoscopic lumbar discectomy, to a more complete foraminal surgical technique that can address spinal stenosis and spinal instability. This expanded capability gives foraminal endoscopic surgery distinct advantages and flexibility for certain painful degenerative conditions compared with open surgery. Advancement of the technique occurred when needle trajectory and placement was refined to better target each type of herniation with precise needle and cannula positioning directed at the herniation. New instrumentation and inclusion of a biportal technique also facilitated removal of extruded, migrated, and sequestered disc herniations. The further development of foraminoscopes with larger working channels and high speed burrs to remove bone more efficiently, along with recognition of foraminal pathoanatomy in the foramen, led to the identification and treatment of other painful degenerative conditions of the lumbar spine such as failed back surgery syndrome, recurrent disc herniations, lateral foraminal stenosis, degenerative spondylolisthesis, and isthmic spondylolisthesis.

A summary of the endoscopic techniques currently used and trademarked by the author as the YESS technique include: (1) a published protocol for optimal needle and instrument placement calculated by lines drawn on the skin from the C-arm image; (2) evocative chromodiscography by the operating surgeon with nonionic radiologic contrast and indigo carmine dye to confirm concordant pain production and to stain tissue in contact with the injectate; (3) selective endoscopic discectomy, which targets the removal of loose degenerative nucleus stained differentially by indigo carmine dye; (4) thermal annuloplasty, a visualized radiofrequency thermal modulation of disc and annular defects guided by vital tissue staining; (5) endoscopic foraminoplasty, a decompression of the lateral and subarticular recess, including disc and foraminal degenerative and isthmic spondylolisthesis; (6) visually and radiologically guided exploration of the epidural space; (7) probing the hidden zone of MacNab for normal nerves (and branches of spinal nerves known as furcal nerves) versus anomalous autonomic nerves in the foramen; and (8) a uniportal and biportal technique for inside-out removal of extruded and sequestered nucleus pulposus.

Endoscopic foraminal surgical procedures are not limited to disc decompression. The approaches and techniques allow access to the lumbar spine for treatment of conditions ranging from discogenic pain to failed back surgery syndrome (most commonly caused by residual or recurrent disc herniation and lateral recess stenosis). More than 3000 patients have undergone endoscopic posterolateral surgical exploration and decompression by the author since 1991. The first 80 patients reported formed the basis for expansion of techniques as new instruments and adjunctive therapy methods were added to selective endoscopic discectomy and thermal annuloplasty. New anatomic and pathoanatomic conditions were reported as they were encountered.

New skills will become desirable and necessary for the spine surgeon to keep up with endoscopic technology in spine care. The emphasis is on visualization of painful pathoanatomy and preservation of mobility. A new focus is on nucleus replacement, annular repair, annular reinforcement, biologics, and even transforaminal interbody fusion as the procedure of last resort. The transforaminal surgical approach to the lumbar spine can allow for minimally invasive access without negatively affecting and destabilizing the multifidus muscle.

• Chymopapain
• arthroscopic microdiscectomy
• endoscopic foraminoplasty
• endoscopic thermal annuloplasty
• evocative chromodiscography
• laser disc decompression
• selective endoscopic discectomy

• Aged
• Aging/pathology
• Animals
• Cadaver
• Compressive Strength
• Disease Models, Animal
• Equipment Design
• Humans
• Injections, Spinal/adverse effects
• Injections, Spinal/instrumentation
• Intervertebral Disc/injuries
• Intervertebral Disc/pathology
• Lumbar Vertebrae
• Manometry/methods
• Needles
• Pressure
• Rupture
• Severity of Illness Index
• Spinal Injuries/etiology
• Spinal Injuries/pathology
• Swine
• Thoracic Vertebrae
• Weight-Bearing

• Equipment Design
• History, 19th Century
• History, 20th Century
• History, Ancient
• History, Medieval
• Humans
• Minimally Invasive Surgical Procedures/history
• Minimally Invasive Surgical Procedures/instrumentation
• Orthopedic Procedures/history
• Orthopedic Procedures/instrumentation
• Spine/surgery

• Adult
• Cordotomy/methods
• Diskectomy, Percutaneous/methods
• Follow-Up Studies
• Humans
• Intervertebral Disc Displacement/complications
• Intervertebral Disc Displacement/surgery
• Low Back Pain/etiology
• Low Back Pain/surgery
• Lumbar Vertebrae
• Male
• Spinal Fusion/methods

• Biomedical Research/economics
• Biomedical Research/ethics
• Biomedical Research/trends
• Conflict of Interest/economics
• Humans
• Industry/economics
• Industry/ethics
• Industry/trends
• Physicians/economics
• Physicians/ethics
• Physicians/trends

• Controlled Clinical Trials as Topic
• Electrocoagulation
• Humans
• Intervertebral Disc Displacement/rehabilitation
• Intervertebral Disc Displacement/therapy
• Low Back Pain/rehabilitation
• Low Back Pain/therapy
• Treatment Outcome

• Biomechanical Phenomena
• Diagnosis, Differential
• Humans
• Injections, Intra-Articular
• Intervertebral Disc Displacement/diagnosis
• Intervertebral Disc Displacement/rehabilitation
• Low Back Pain/etiology
• Low Back Pain/rehabilitation
• Lumbar Vertebrae/physiopathology
• Occupational Diseases/rehabilitation
• Zygapophyseal Joint/injuries

• Adult
• Diskectomy, Percutaneous/instrumentation
• Electrocoagulation/instrumentation
• Female
• Fluoroscopy
• Follow-Up Studies
• Humans
• Intervertebral Disc Displacement/diagnostic imaging
• Intervertebral Disc Displacement/surgery
• Low Back Pain/diagnostic imaging
• Low Back Pain/surgery
• Lumbar Vertebrae/diagnostic imaging
• Lumbar Vertebrae/surgery
• Male
• Middle Aged
• Pain Measurement
• Radiography, Interventional/instrumentation
• Sciatica/diagnostic imaging
• Sciatica/surgery