Welcome to Pain and Spine Clinics

Intradiscal biacuplasty is a minimally invasive treatment for low back pain related to the intervertebral disc problems. It is aimed at providing pain relief and functional improvement.

 

Method:

Biacuplasty procedure uses a new method, known as water-cooled radiofrequency (RF) ablation to treat damaged intervertebral discs that cause pain. The RF probe sends radio waves that produce heat within the target disc to block nerves and repair the damaged collagen.

 

Benefits:

Discogenic pain is usually treated surgically, with procedures such as spinal fusions and disc replacement, which can be risky, complicated and take longer to recover from. They may fail and worsen the pain, causing Failed Back Surgery Syndrome. Biacuplasty has a short recovery time and does not involve the aforementioned complications of surgery.

After the procedure, a patient should undergo physical therapy

Inclusion criteria:

  • Age ≥ 21
  • History of chronic low back pain (>6 months) refractory to non-operative treatment options,
  • On pain medication for >2 months
  • Leg pain (not due to nerve compression, not extending below the knee, not greater than 50% of overall pain),
  • Single level concordant pain reproduced present on lumbar discography in the involved disc,
  • Minimal disc height loss (must be at least 50% of adjacent control disc).

Contraindications:

  • Presence of disc height of less than 50% than adjacent disc when measured on lateral radiographs
  • Presence of disc degeneration at greater than 2 lumbar levels on sagittal planes of spinal MRI.
  • Significantly overweight patients
  • Patients receiving workman’s compensation benefits.

 

What to expect after the procedure:

After the procedure, the patient should undergo physical therapy. Oral opioid may be used for 1 to 2 weeks, followed by nonsteroidal anti-inflammatory drugs (NSAIDs) adequate pain relief.  Muscle relaxants can be considered by the doctor as needed. A lumbar sacral orthosis (LSO) is advised to be worn for 4 to 6 weeks following the procedure. Patients should be educated on how to prevent re-injury and return to work/routine activities. For postprocedural pain, ice/heat packs should be considered.

 

Functional Rehabilitation:

Week 1: Short periods of walking; no driving; minimal weight lifting (10 lbs)

Week 2: Mild exercise such as gentle stretches, light weight lifting (20-40 lbs) but no strenuous activity, twisting or sustained flexion.

Weeks 3-4: Therapist guided stretching, strengthening, range of motion exercises. Neutral-biased dynamic stabilization program may be considered; Minimal driving (≤30 minutes).
Weeks 5-6: Progressive strengthening, endurance exercises; NSAIDs as needed.

Weeks 6-8: Dynamic lumbar stabilization as tolerated with limited truncal rotation; may consider swimming, bicycling, and supervised aerobic exercises; no more orthosis.

Complications:

Warning signs of postprocedural complications include:

  • Stiff neck
    • Increasing pain
    •   Lower extremity paresthesia
    •   Motor deficits
    •   Bladder or bowel dysfunction
    •   Wound site drainage

Complications include:

  • discitis
  • epidural abscess
  • bacterial meningitis
  • Acute paresthesias
  • Muscle spasm
  • bleeding

Postprocedural disc herniation