Current evidence on percutaneous electrothermal treatment of the intervertebral disc annulus for low back pain and sciatica raises no major safety concerns. The evidence on efficacy is inconsistent and of poor quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research.
Clinicians wishing to do percutaneous electrothermal treatment of the intervertebral disc annulus for low back pain and sciatica should:
Inform the clinical governance leads in their NHS trusts.
Ensure that patients understand the uncertainty about the procedure's efficacy and provide them with clear written information. In particular, patients should be informed about other treatment options, about the possibility that the procedure may not relieve their symptoms, and about the risk of a flare‑up of their pain following treatment. In addition, the use of the information for the public is recommended.
Audit and review clinical outcomes of all patients having percutaneous intradiscal radiofrequency treatment of the intervertebral disc annulus (see further information).
NICE encourages further research into percutaneous electrothermal treatment of the intervertebral disc annulus. Further research should document details of patient selection, including the duration of their symptoms. It should report precise details of the technique used for treatment. Outcome measures should include pain relief and quality of life. Long‑term follow‑up data should include details of any subsequent procedures.