IDET Treatment For Back Pain

Intradiscal Electrothermic Therapy (IDET) is a relatively new, minimally invasive, procedure developed to treat chronic low back pain due to a spinal disc problem. It may be recommended for people who have had chronic disc related low back pain for at least 3 to 6 months.

It can be used to treat:
• Small disc herniations
• Internal Disc Tears
• Mild disc degeneration which is limited to one or two levels

Degeneration of the disc
Experts believe some cases of persistent disc pain may be caused by nerve fibers that have migrated from their normal location in the outer layers of the disc into its interior. The degeneration of the disc with age or injury is characterized by the breakdown of the tough outer layers of the disc, allowing fissures to develop in its walls. Filled with blood vessels and small nerves, these fissures can become a source of chronic pain in many patients.

Injury to the disc
If there has been a back injury which compressed the intervertebral disc, causing it to bulge or herniate, material from its center will protrude, stimulating pain sensors within the disc. This material from the nucleus of the disc is irritating and adds to the pain.

Before an IDET procedure is done, a discography should be completed to clearly identify the problem. IDET is not recommended for:
• Severe disc degeneration
• Spinal stenosis
• Spinal instability as with spondylolisthesis

The Discogram is the primary diagnostic tool although an MRI (Magnetic Resonance Imaging) may also be done. With a Discogram, a needle is placed in the affected disc and a small amount of dye is injected. This provides information on the disc structure and pain source. It is very important that an accurate diagnosis is made and the disc identified as the source of the pain. IDET is not recommended for pain symptoms due to problems with spinal structures, such as nerve roots or spinal joints. It is important that the disc itself be identified as the primary source of pain.

Before the Surgery (Preoperative)
One week before the surgery, the following should be done:
• Stop taking NSAIDs (Nonsteroidal Antiinflammatory Drugs), aspirin and aspirin compounds.
• Continue taking any prescribed heart, blood pressure or diabetic medications.

• Be sure to alert your physician if you are:
o Taking blood thinners or have a history of a bleeding disorder
o Allergic to iodine (can’t tolerate shellfish or allergic to IVP dye)
o Having any illness, elevated temperature or sign of infection
• DO NOT eat the day of the procedure.
• Your physician may permit a small amount of clear soup, broth or juice. Be sure to ask.
• Arrange to have someone drive you home.

The Procedure
• An IV will be started and you will be given a mild sedative.
• You will be positioned on the x-ray table and given a local anesthetic.
• The doctor will insert a hollow needle into the disc. The process will be visualized on fluoroscopy.
• An electrothermal catheter or heating wire is inserted through the needle and positioned in the disc.
• The wire or catheter is slowly heated to about 194° F for about 15 minutes. This heat causes the disc walls to thicken and heal small tears as it destroys the nerve endings.
• An antibiotic may be given IV or directly into the disc to prevent any infection.
• The needle will be removed and a dressing applied to your back.
• You will be observed in a recovery area until you are ready to go home.

After Surgery
• Pain may be more noticeable after the procedure, lasting 2 or 3 days.
• Physical therapy will be prescribed.
• Restrict bending and lifting during recovery and avoid sitting for long periods of time.
• A lumbar support may be prescribed for up to 8 weeks.
• Walking and easy stretches are recommended.
• Activities such as swimming, running or tennis should not be resumed for at least 6 months.

This is the least invasive type of spinal procedure. Complications are rare but possible risks include:
• Weakening of spine
• Disc infection
• Nerve damage
• Disc damage

Pain may remain for up to 3 months after the procedure. There have been no large long term studies to evaluate the effectiveness of IDET.