Discogenic Low Back Pain
Discogenic low back pain is a common, multifactorial pain syndrome that involves low back pain without radicular symptoms findings, in conjunction with radiologically confirmed degenerative disc disease.
Typical treatment includes conservative therapy with physical therapy and medication management, with potential for surgical decompression in more severe cases.
Laser discectomy and radiofrequency coblation (disc nucleoplasty) are considered investigational as techniques of disc decompression and treatment of associated pain.
Practice Guidelines and Position Statements
National Institute for Health and Care Excellence
In 2016, the National Institute for Health and Care Excellence NICE) updated its guidance on laser lumbar discectomy for the treatment of sciatica. The guidance stated that current evidence “is inadequate in quantity and quality.”
NICE also updated its guidance on percutaneous disc decompression using coblation for lower back pain and sciatica in 2016. NICE stated: “Current evidence on percutaneous coblation of the intervertebral disc for low back pain and sciatica raises no major safety concerns. The evidence on efficacy is adequate and includes large numbers of individuals with appropriate follow-up periods.” The guidance also noted that the individual should be informed of the range of treatment options available.
American Pain Society
American Pain Society practice guidelines (2009) on nonsurgical interventions for low back pain found that “there is insufficient (poor) evidence from randomized trials (conflicting trials, sparse and lower quality data, or no randomized trials) to reliably evaluate” a number of interventions including coblation.
American Society of Interventional Pain Physicians
Practice guidelines on lumber disc compression and chronic spinal pain were published in 2009 and updated in 2013, respectively, by the American Society of Interventional Pain Physicians.The systematic reviews informing the 2013 guidelines found limited evidence for percutaneous laser disc decompression and limited to fair evidence for nucleoplasty.