Percutaneous intradiscal radiofrequency treatment of the intervertebral disc nucleus for low back pain

5 Safety

This section describes safety outcomes from the published literature that the Committee considered as part of the evidence about this procedure. For more detailed information on the evidence, see the interventional procedure overview.

5.1 Flare‑up pain lasting from a few days to 6 weeks was reported in a case series of 76 patients with discogenic pain treated by pulsed radiofrequency in the intervertebral disc nucleus. The pain was treated by non‑steroidal anti‑inflammatory drugs or paracetamol (number of patients not reported).

5.2 Disc herniation was reported in 5% (2/39) of patients in a case series of 39 patients with low back pain treated by percutaneous intradiscal radiofrequency thermocoagulation, but it was unclear whether this was associated with the procedure (timing not reported).

5.3 In addition to safety outcomes reported in the literature, specialist advisers are asked about anecdotal adverse events (events which they have heard about) and about theoretical adverse events (events which they think might possibly occur, even if they have never done so). For this procedure, specialist advisers listed the following anecdotal adverse events: visceral or vascular injury and discitis. They considered that the following were theoretical adverse events: instrument failure; technical failure at L5 or S1 (lumbosacral joints) because of difficult access; needle misplacement through disc to retroperitoneum or behind to dura or spinal canal; damage to other structures including nerve damage; bleeding; infection; instability; infarction; epidural fibrosis; late disc protrusion; and paralysis.