Biacuplasty – Disc Denervation
If you suffer from chronic neck pain, mid/upper back pain or lower back pain from a herniated or bulging disc, this cutting-edge treatment may be able to help.
What is Biacuplasty?
Biacuplasty is a brand new treatment modality for performing disc denervation – a method for treating chronic discogenic (disc related) pain. This state-of-the-art procedure uses an innovative and highly sophisticated technologic advancement known as water-cooled radiofrequency (RF) ablation to treat painful, injured intervertebral discs. Energy is created within the target disc by special radio waves that heat the inside to block painful nerves, and repair the damaged collagen.
Biacuplasty is a frontline treatment on the absolute cutting-edge of pain management technology. This truly amazing procedure uses a highly advanced form of radiofrequency ablation to heal painful discs from the inside. There are no incisions or cutting of any kind.
Biacuplasty is used to treat discogenic pain or disc-related pain.
Discogenic pain is conventionally treated with surgery, i.e. spinal fusions and disc replacements. Unfortunately, these types of surgery are extremely invasive with extensive recovery times. What’s more, the chances of these types of surgery being a success can be no better than a coin flip. In many cases, the pain may even worsen – this is called Failed Back Surgery Syndrome. Biacuplasty is an easy, effective and minimally invasive method for treating discogenic pain. In successful cases, patients are able to avoid surgery and return to the acitivities they love without a painful postoperative recovery.
- Nucleus pulposus – soft gel-like inner portion
- Annulus fibrosis – the fibrous outer ring that surrounds and holds in the nucleus pulposis
Discs themselves can be rich with sensory innervation. The sensory component of intervertebral discs is extremely complex and differs depending on the location within the spinal column. The annulus has been shown to have both nociceptive (pain) nerve fibers as well as mechanoreceptors. Sensory innervation of the discs is transmitted through a small branch of the vertebral nerves called the sinuvertebral nerve as well as branches of the ventral primary rami and rami communicantes.
When a tear or imperfection in the annulus forms (annular tear), the nucleus will penetrate through the annulus causing a disc bulge or herniation. More importantly, this annular tear will itself be extremely painful – this causing discogenic pain. Discogenic pain can also occur when discs develop shearing forces or less than perfect mechanics with movement due to loss of water within the nucleus, degenerative disc disease (DDD), trauma, or excessive lifting. This pain is aggravated with movement of the spine and is axial, meaning it tends to stay along the midline of the back and does not radiate.
What Are The Benefits of Biacuplasty?
Discogenic pain is one of the most common causes of chronic back pain and accounts for as much as 10% of all complaints of low back pain. The discs themselves can be the source of pain (discogenic pain) in 39% to 65% of all patients with non-radiating low back pain. In these cases, conventional treatment options (chiropractic, epidurals, etc) will almost surely fail. Given the extremely poor blood supply to the intervertebral discs, any tears or damage to the disc will remain unchanged, despite these treatments, and continue to be painful each and every time the spine causes that particular disc to sense movement. Without an adequate blood supply, the damaged fibers are unable to access the body’s allocation of healing elements and nutrients to repair the damage. The only way to treat discogenic pain is to prevent the painful disc from moving (fusion) or internally repair the damage to the disc (biacuplasty).
Biacuplasty is unique in that is can eliminate discogenic pain without fusing the spine or replacing the disc – both of which require major surgery.
Biacuplasty uses an advanced type of radiofrequency ablation (RFA) to treat painful discs from the inside. By applying the energy of RFA to the inner portion of the disc, one can effectively denervate a damaged disc (rendering it painless) while simultaneously repairing some of the damaged collagen within the annulus.
In essence, biacuplasty deploys thermal energy to a painful disc (the annulus fibrosis), but differs from traditional RFA in that it delivers bipolar RF energy via two thin electrode probes placed in close proximity within the disc. These probes are internally cooled during the ablation portion of the procedure allowing bipolar RF energy to heat annular tissue adjacent to and between the two electrodes while the tissue in immediate contact with each electrode probe is actively cooled. This unique and innovative cooling system produces a larger volume of ionic tissue heating within the disc with a concentrated current in its posterior portion – meanwhile avoiding charring, rising impedances, ineffective intradiscal tissue heating, unpredictable RF energy delivery, or involvement of the spinal cord or adjacent vertebral nerves.
*Biacuplasty was invented to improve upon the inadequacies and deficiencies of a previously used technique for treating discogenic pain – Intradiscal Electrothermal Therapy (IDET).
The positive effects of the procedure can vary from one person to the next and also depends on the severity of the pain. Most patients will begin to report pain relief in a matter of days after the treatment.
Am I a Candidate for Biacuplasty?
Selection criteria for biacuplasty include:
Low back pain greater than 6 months in duration
Back pain nonresponsive to conservative treatment
Back pain greater than leg pain
Positive well-performed discogram
Presence of an annular tear as documented by either discogram or MRI
Disc disease limited to one or two levels
Disc height ≥ 50% of normal
Body mass index <30
Patient is less than 55 years of age
No evidence of compressive radiculopathy other than diminished ankle reflexes
Disc bulges ≤ 5 mm
No prior surgery at the treated level
Procedure - Patient Details
Before performing biacuplasty, your physician will first perform a discogram. This will allow your physician to better establish a diagnosis of discogenic pain as it will allow him/her to discover which disc is the pain generator and see where the damage has occurred. Once the painful, damaged disc has been identified, biacuplasty may be recommended.
The procedure for performing biacuplasty is nearly identical to that of a discogram – but rather than one thin needle, there are two, one on either side of the disc. As with a discogram, the procedure is performed as an outpatient and can be completed with a small amount of local anesthetic. Fluoroscopy will also be used to aid in the positioning of the needles.
Once properly positioned, a small, hair-thin probe will be inserted within each of the needles. At this point, a heat sink is created within the disc using the cooled bipolar RF energy. This portion of the procedure will ablate the pain transmitting nerves within the injured disc and affect the damage and imperfections of the collagen within the annulus to start the healing process – all the while preserving the spinal cord and nearby nerves, leaving them unharmed. The probes and needles are then removed and two small Band-Aids are applied. The entire procedure takes less than 20 minutes.
Complications from biacuplasty and other forms of disc denervation are rare. There may be some soreness after treatment at the procedure site, but is typically controlled with oral medication. The general risk and complication profile is same as that of a discogram.
Evidence of Performance
RFA is one of the most widely used modalities for treating pain of all types, using it for discogenic pain, on the other hand, is a relatively new procedure. Biacuplasty is the most advanced form of disc denervation and the evidence to support its efficacy is extremely encouraging. Kapural at the Cleveland Clinic first reported Biacuplasty in 2007. Since that time there have been an abundance of studies documenting one success after another in treating discogenic pain with biacuplasty.
In an observational study published in 2008, 15 patients with chronic discogenic low back pain were treated with biacuplasty. These patients reported a significantly significant decrease in pain at 3 and 6 month follow ups, as well as improved function and decreased opioid consumption. In a follow up study, it was noted that the improvements in pain and function persisted beyond 12 months and no complications were noted.
In a study published in 2011, 15 patients with chronic discogenic pain were treated with biacuplasty at 1 or 2 levels. The authors followed the patients for 6 months and reported 57.1% of patients had a 50% or more reduction in pain, while 78.6% of patients reported a reduction of at least two points in their VAS values. Even more impressive was that 78.6% of patients reported a 10-point improvement in their Oswestry Disability scores compared to the initial values – meaning their overall function was improved.
The Ainsworth Institute is Here to Help
If you are suffering from low back pain and other treatment options have failed bring pain relief, then you may be a candidate for this innovative, groundbreaking treatment option. There are but a few centers throughout the country able to offer biacuplasty – the Ainsworth Institute of Pain Management is proud to be one those few on the cutting edge to offer it. Contact our office today to find out more.
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