In order for a technology to be medically recognized, a judgment must be made about the level of evidence required for it to move from an experimental status to an innovative status. This judgment takes into account both the uncertainties regarding its efficacy and safety, and the necessity to sustain innovation to improve the quality of care. Especially in situations where the new technology is used to treat serious diseases for which there are few or no other treatments, assigning innovative status can be considered reasonable, even if this decision is based on limited evidence. However, this approval should be conditional upon field research being conducted to assess the effectiveness of the technology.
In the present case, the lack of other proven treatments constitues an argument in favour of assigning an innovative status to intradiscal electrothermal therapy for the treatment of discogenic low back pain that does not respond to any type of conservative treatment, in particular, intensive multidisciplinary therapy. In addition, intradiscal electrothermal therapy is a much less invasive procedure than spinal fusion, which is presently considered an accepted technology, even if the evidence regarding its efficacy hardly seems any better than that for electrothermal therapy.
The decision to include this technology as an insured service should be conditional upon it being used by appropriately trained physicians in medical settings where continuous evaluation and research are conducted and upon the creation of clinical registries for evaluating its effectiveness in Quebec. It would be desirable to include in these registries the spinal fusions performed for the treatment of chronic low back pain, in order to determine their effectiveness as well and to improve the overall quality of the treatment of chronic back pain in Quebec. These registries could be under the responsibility of university hospitals and of the integrated university health-care networks (IUHNs), which are presently being implemented in Quebec.