Controlled scientific studies on Intradiscal Electrothermal Therapy (IDET) clearly prove that, for selected patients, IDET is an effective method for the treatment of back pain. About 75% of those undergoing treatment report satisfactory outcomes of reduced pain and increased mobility.
IDET helps many low back patients significantly reduce pain and improve function. Furthermore, it reduces medical costs when compared with the option of spinal fusion.
Cracks or fissures in the wall of the intervertebral disc frequently are the cause for back pain. The discs are filled with small nerve endings and blood vessels. Irritation of these nerves is a chronic source of pain in many patients. Furthermore, the center inner area and tissue (the nucleus) may cause the disc to bulge or herniate into these cracks, in the outer region of the disc. This can also stimulate pain sensors within the disc. The IDET minimally invasive procedure offers a non-surgical option to treat back pain. A catheter that uses heat modifies the protein wall of the disc and reduces the amount of disc material that causes nerve irritation. The physician applies controlled levels of heat to a broad section of the affected disc wall. This heat contracts and thickens the collagen of the disc wall, and raises the temperature of the nerve endings. This results in contraction or closure of the disc wall fissures, a reduction in the bulge of the inner disk material, and a desensitization of the pain sensors within the disc.
IDET therapy acts exclusively upon the tissues of the disc itself, and should not be expected to relieve symptoms arising from other spinal structures, such as nerve roots or spinal joints. It is therefore very important for your physician to diagnose that the disc is the primary source of your back pain. In addition to a clinical examination, your physician may use Magnetic Resonance Imaging (MRI) or injections of dye into the disc (discography - see description in the Diagnostic Procedures section) to confirm the diagnosis. Once the physician determines that one or more discs are the primary source of the patient's lower back pain, the pain physician may recommend IDET.
After the patient is sedated (I.V. with light sedative placed in arm) he or she is positioned on the fluoroscopy table and x-ray equipment identifies the disc level(s). Lower back skin and muscle tissue is numbed with local anesthetic. A needle is placed into the patient's disc under x-ray guidance. The patient may experience pressure during this part of the procedure. Once the needle is in the proper position, the physician may inject dye into the disc for diagnostic purposes.
The electrothermal catheter is then inserted through the needle. Patients typically do not feel any discomfort during this step. However, some patients feel pressure in their back when the catheter moves through the disc.
When the catheter position is confirmed by x-ray, the heating element is activated. The heat is slowly increased and will last for about 15 minutes. As the heat increases into the treatment range, the patient may experience typical disc-related symptoms. The physician monitors patient responses during the procedure to ensure that any discomfort reported by the patient is properly controlled.
The procedure takes about one hour to complete.
At the end of the procedure, a bandage is placed on patient's back, and the patient is recovered. When patient is ready he or she will need a driver to take them home.
After the Procedure
Some patients report increased back pain during the first three days after the IDET procedure. Rest, ice, pain medication and anti-inflammatory medications can reduce discomfort during this time. Any unusual or new symptoms (i.e., fever, chills, rash, increased numbness or weakness) should be reported to the physician. Pre-procedure symptoms will not disappear immediately the procedure.
Post-IDET patients are asked not to exert themselves during this time, even if they experience a marked reduction in their usual pre-procedure pain. Exertion may compromise an overall positive outcome. Housework, lifting or bending are to be avoided. Short walks (15 to 20 minutes) are okay, but generally the first few days should be spent resting. Patients should discuss their plans to return to work, if appropriate, with their physicians. In most instances, patients with sedentary work can return to their jobs 1 to 5 days after the procedure. A follow-up appointment is usually made with the physician for additional treatment recommendations.
After a few weeks following the procedure patients report a reduction in pain. However, pain reduction may occur over 3 months. During the first month, patients must treat their backs carefully. Bending, twisting or heavy lifting must be strictly avoided. Patients are instructed to wear a soft lumbar brace for several months following the procedure. Sports, in general, are not allowed. The physician may prescribe specific back exercises designed for post-IDET patients. Discomfort associated with the patient's normal back pain can be reduced with anti-inflammatory medications and/or pain medications. Icing 1-2 times per day (10-15 minutes) can also help.
With proper post-procedure outcome and follow-up, many patients can return to sports activities about three-to-four months after the procedure. The same applies for traveling for work or pleasure during this time, as well.
An excellent page describing this procedure can be found at Oratec's site. Oratec is a manufacturer/distributor of the catheters used in IDET procedures.
IDET is a very safe procedure with a very low risk for complications. Disc space infection and nerve injury are seen less than 1% of the time. No serious complications have been reported in the scientific literature. The potential risks associated with this treatment are similar to the risks associated with the standard diagnostic test of discography. These include; temporary general low back pain, infection, swelling, and temporary loss of some sensations. Patients sometimes report a feeling of high level of discomfort during the treatment. This is caused by the placement of the needle and the presence of the catheter in the disc. Patients may suffer an unanticipated reaction to sedative or antibiotic medications that are administered during the treatment. Some patients report little or no improvement as a result of the procedure, while, yet others feel increased discomfort at the site of the needle placement from one to four weeks after treatment. There is a small risk of injury to the spinal nerves in the spinal canal, believed to be less than 1 in 10,000. This may cause a change in sensation in the leg and/or leg muscle control. Monitoring during the procedure should avoid this problem. There is a risk that the equipment could break inside the back, estimated to be less than 1 in 1,000. This may require immediate surgical removal of any pieces.