Intradiscal Electro Thermal Annuloplasty
I write in support of covering Intradiscal Electro
Thermal Annuloplasty 22526, 22527.
By now you have been provided extensive literature on this
subject. The best of thesupport comes from a prospective 2 cohort series
comparing IDET (aka ITA, IDTA, IDTT) to radiofrequency annular ablation (aka
RFA). The results were dramatically favorable for IDET but unfavorable to RFA. (Kapural
et al. Itradiscal thermal annuloplasty versus intradiscal radiofrequency ablatin
for the treatment of dicogenicpain: a prospective matched control trial. Pain
Med 2005 6;6:425-31.)
I have been employing the technique since shortly after its
release. I have only been performing a few per year due to non-coverage. I have
no financial interest in any of the products and am not a consultant. In
carefully selected patients who have severe lumbar pain with activities such as
sitting and who have concordant provocation discography, my results have been
about 80% positive results; that means greater than 50% relief, improved
function and reduced medication. Here are just two vignettes:
A 911 dispatcher in her mid 50s presented with severe back
pain particularly with sitting.
Her job required her to sit for up to 10 hours per day. She
had reduced her hours to and average of 2 per day. She had multilevel
degenerative disk disease but only one disc that provoked concordantly on
provocation discography. IDET provided gradual but dramatic improvement. By
three months she had returned to 10 hour per day work in comfort with no
narcotic use.
A 34 year old delivery truck driver presented with severe back
pain, intermittent sciatica and addiction to opioids. He had taken medical leave
of work and found himself out of control with medication use trying to control
his pain. He had severe concordant pain at
L5-S1 and severe discordant pain at L4-5 and L3-4. He was
treated with IDET. At 6 weeks he was able to go camping with his son's Boy Scout
troop. At 3 months his pain was almost completely gone and had stopped using
opioids. At 3 months I released him to light duty with a 40# weight restriction,
but the employer did not accept him until I returned him without restrictions at
6 months.
To be successful, an interventional pain physician must have
available a variety of tools, including IDET. One tool will not treat all
patients. Individual patients must be properly diagnosed and treatment fitted to
the individual. IDET will not be the right
treatment for every patient with back pain. When appropriate,
as exemplified above,
proper IDET can dramatically improve symptoms, restore
patients to work, family and recreation, restore financial independence, and
reduce opioid consumption.
Coverage should provide improved access to care by many
deserving patients and give them a
better chance of returning to wellness. Reimbursement should
be adequate to cover the
physician fees, facility costs and permit pass through of the
device cost. Please, find favorably in the coverage decision for IDET.
Joseph F. Jasper, MD
ASIPP Member
Tacoma, WA
