• Leonardo Kapural, Katarina Sakic, and Kaylea Boutwell.
• Department of Pain Management, Cleveland Clinic, Cleveland, OH 44195, USA. Kapural@ccf.org
• Clin J Pain. 2010 May 1;26(4):354-7.

ObjectivesDiscogenic pain in the thoracic region is a challenging condition characterized by refractoriness to conservative treatments. Unlike lumbar discogenic pain there is a lack of effective surgical options. Reported here is the treatment of thoracic discogenic pain in 3 patients using a new minimally invasive procedure named intradiscal biacuplasty.MethodsClinical case series in outpatient clinical setting. The procedure is detailed and step-by-step fluoroscopic imaging is presented.ResultsNo intraoperative and postoperative complications were reported. Improvements in functional capacity and pain scores were noted in 2 patients. Visual analog scale pain scores changed from 10 to 2 cm and 7 to 3 cm in 2 patients who claimed improvements at 12 months follow-up. In patient 1 visual analog scale went from 7 to 8 cm claiming no improvements after the procedure. In patients 1 and 3, Oswestry Disability Index improved from 24 to 8 and 10 points, respectively, and SF-36 physical function score changed from 55 to 80 and 45 to 82, respectively. The patient 2 showed no improvements with Oswestry (28 to 32) and SF-36 physical function score (50 to 45) at 12 months after intradiscal biacuplasty. Patient 1 stopped using his oxycodone/acetaminophen 5/325 mg that he used previously at 6 tablets a day, patient 3 decreased use of his duragesic patch from 75 microg/h to 25 microg/h. Patient 2 continued with significant use of opioids (100 microg/h of transdermal fentanyl).DiscussionCooled, bipolar radiofrequency may be an effective and readily available treatment for thoracic discogenic pain if future comparison studies show benefits of such procedure.

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