Background & Aims
Low back pain impacts 80% of the population throughout their lifetime [1]. A subcategory of low back pain, Discogenic Back Pain (DBP), is pain attributed to pathology associated from the disc itself. Classic patient presentation is pain elicited with lumbar flexion when sitting or leaning forward. Imaging may help with diagnosis as degeneration may show as hypointense disc on T2 weighted imaging with associated Modic changes on MRI. One proposed treatment (VIA Disc) in the management of DBP is through minimally invasive injection of an allograft to supplement the nucleus pulposis tissue lost during disc degeneration. We present a case report of a patient who received VIA Disc injections with successful management of the patient’s discogenic pain including pre-operative and post-operative pain scores, functional status, and medication requirements.
Methods
A retrospective case review of a patient who received VIA Disc NP injection was conducted at an academic pain clinic. The patient received a total of 3 levels of VIA Disc NP injections at two different occurrences. The procedure is performed using fluoroscopy via a parasagittal approach with oblique angulation. An introducer needle is directed into the disc space using the Superior Articular Process (SAP) as an anatomic landmark. The needle is positioned superior to the SAP and advanced using lateral and oblique views. Once positioned into the disc, the allograft is injected. A review of the pre-operative, post-operative Numerical Pain Score (NRS), functional improvement, and opioid medication requirements was performed.
Results
The patient is a 63 year old male with a medical history of prostate cancer, esophageal cancer status post esophagectomy, and chronic low back pain without any inciting injury who presented to our clinic for co-management of abdominal pain and low back pain. Abdominal pain has been primarily managed with opioid medications. The patient’s low back pain has been managed through conservative measures and multiple injections without substantial relief. For the first procedure, NRS scores pre-operatively and postoperatively were 8/10 and 4/10, respectively. The patient endorsed >80% pain relief at 1 month, 5 month, and 7 months post-operatively with functional improvement from 5 meters to >10 kilometers walking tolerance. Opioid management for chronic back trended from 22.5 Morphine Milligram Equivalence per day (MME/day) to 7.5 MME/day. For the second procedure, NRS scores preoperatively and postoperatively were 4/10 and 0/10, respectively, with follow-up appointments pending.
Conclusions
We suggest that VIA Disc is a minimally invasive treatment option that should be considered early in the management of discogenic back pain as it has been shown to improve pain scores and functionality. Early evidence [2] suggests that the procedure is an effective, safe option.
References
1. Remotti E, Nduaguba C, Woolley PA, Ricciardelli R, Phung A, Kim R, Urits I, Kaye AD, Hasoon J, Simopoulos T, Yazdi C, Robinson CL. Review: Discogenic Back Pain: Update on Treatment. Orthop Rev (Pavia). 2023 Aug 25;15:84649. doi: 10.52965/001c.84649. PMID: 37641793; PMCID: PMC10460631.
2. Beall DP, Wilson GL, Bishop R, Tally W. VAST Clinical Trial: Safely Supplementing Tissue Lost to Degenerative Disc Disease. Int J Spine Surg. 2020 Apr 30;14(2):239-253. doi: 10.14444/7033. PMID: 32355632; PMCID: PMC7188098.
Presenting Author
Raheleh Rahimi Darabad
Poster Authors
Topics
- Treatment/Management: Interventional Therapies – Minor surgical procedures