IDET (Intradiscal Electrothermal Annuloplasty) provides a new alternative to other surgical procedures for patients who suffer from back pain caused by certain types of disc problems. It is a fairly advanced procedure made possible by the development of electrothermal catheters that allow for careful and accurate temperature control. The procedure works by cauterizing the nerve endings within the disc wall to help block the pain signals. IDET is a minimally invasive outpatient surgical procedure developed over the last few years to treat patients with chronic low back pain that is caused by tears or small herniations of their lumbar discs.
IDET is currently indicated for patients with chronic back pain that do not respond to at least 6 months of conservative treatment. Conservative treatment typically includes a combination of: Medication, Rest, Activity modification, Physical therapy, and/or an appropriate exercise program. It is important to note that at least 90% of people get better with the above treatments and do not require additional treatment. For those who fail to respond and have significant limitations in their daily function, additional testing such as MRI Imaging and Lumbar Discography are useful in determining which discs, if any, may be responsible for the chronic pain.
Candidates for IDET include patients with back pain caused by: Small herniations, Internal disc tears, and mild disc degeneration limited to one or two levels.
Relative contraindications for IDET include: Severe disc degeneration, Spinal stenosis, Neurological symptoms (such as leg weakness) and Large disc herniations.
The IDET process takes about an hour to complete and is done as follows:
• The procedure is performed with a local anesthetic and mild intravenous sedation;
• A hollow introducer needle is inserted into the painful lumbar disc space using a portable x-ray machine for proper placement;
• An electrothermal catheter (heating wire) is then passed through the needle and positioned along the back inner wall of the disc (the annulus), the site believed to be responsible for the chronic pain;
• The catheter tip is then slowly heated up to 90 degrees Celsius for 15-17 minutes.
• The heat contracts and thickens the collagen fibers making up the disc wall, thereby promoting closure of the tears and cracks. Tiny nerve endings within these tears are cauterized (burned), making them less sensitive;
• The catheter is removed along with the needle and, after a short period of observation, the patient goes home;
• A lumbar support is worn for 6 to 8 weeks, followed by an appropriate course of physical therapy. Lifting and bending precautions are necessary during this time to allow for adequate healing of the disc.
Studies have shown that approximately 70% to 80% of patients are satisfied with the procedure. General areas of improvement include:
• Most of these patients report an increased activity level and improved sitting tolerance
• The usage of pain medication seems to be diminished
• Improvement is frequently noted within a few days of the procedure but may take up to 6 to 8 weeks to be noticed. Improvement may continue for 4 to 6 months
• Results so far suggest that most people who feel significant improvement after one year continue to do well at two years of follow-up
Several factors seem to help predict a successful outcome, including:
• Single level disc disease
• Good catheter placement at the time of the procedure
• Absence of secondary gain issues (such as financial gain from pending litigation or workers compensation).
This last factor – secondary gain – clearly impacts the outcome of all spinal procedures.
Potential risks and complications of IDET : 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 yet been reported.