Aseptic Spondylodiscitis Resulting from Intradiscal Radiofrequency Ablation (IDRA) in Patients with Herniated Disc Disease: A Report of Ten Cases

Abstract

The purpose of this study was to investigate the clinical presentation, radiological features, management, and outcomes of aseptic spondylodiscitis after Intradiscal radiofrequency ablation (IDRA). Methods: Between 2014 and 2015, ten patients were diagnosed with aseptic spondylodiscitis due to significant back pain after IDRA and were assessed with medical record review, telephone interviews, and imaging. The follow-up period was 12 months. Results: The patients developed significant axial pain after the procedure (VAS, 2±1.6 to 8±0.7, p<0.001). Laboratory findings, including WBC, ESR, and CRP, were nonspecific. Magnetic Ressonance Imaging (MRI) showed low intensity on T1-weighted images, heterogeneous intensity on T2weighted images, and contrast enhancement on the subchondral area adjacent to the endplate. All patients were treated conservatively with non-steroidal anti-inflammatory drugs. Back pain improved gradually in 3 months (VAS, 5.5±1.3, p<0.01).All patients had no sequelae at final follow up. Conclusion: IDRA may cause thermal injury to adjacent vertebrae. If a patient complains of significant back pain after IDRA and show osteonecrosis characteristic on MRI, aseptic spondylodiscitis should be considered. To prevent this complication, the correct location of the IDRA tip distant from the endplate should be confirmed by fluoroscopy during the procedure.