What is IDET

Who Needs IDET?

Pain Can Linger as a Result

Spine specialists have the most difficulty when diagnosing and treating axial low back pain. This type of pain is in the lower back only and does not radiate to a leg. The reason this can be difficult is that there are so many possible causes – disc, bone, muscle, or ligaments problems. This can make it difficult to pinpoint the real issue. In these cases a barrage of tests may be required like those talked about in the chapter called What Test Needs To Be Perform For Back And Neck Pain? . Often times injections and different therapies are done on a trial and error basis that can end up wasting a lot of time.

Quite often the cause of axial low back pain can be narrowed down to a degenerated disk, something that happens to a lot of people as they get older. Over time, the annulus of the disc, which is the disc’s outer wall, can develop tiny tears. Sometimes the contents of the disc and seep through the wall completely and end up in the spinal canal. This is a herniation. These tears as well as the fluid that gets into the canal send pain signals to the brain.

Up until recently, the only answer for pain caused by a herniated disc was to have surgery to fuse the disc. See the section on What Actually Happens in Back Surgery for details on how fusion surgery is done. But in 1997 a new treatment for axial low back pain was developed. This new procedure treats the pain using heat applied to the disc. Seventy percent of people who have this treatment report a significant decrease in pain.

What is IDET

This new procedure is called IntraDiscal Electrothermal Therapy (IDET) and is can be a successful alternative to having disc fusion surgery. An IDET treatment is only slightly invasive and involves the application of controlled amounts of heat in the form of thermal energy to a wide section of the disc wall. The heat causes the collagen in the wall of the disc to thicken and contract, while elevating the temperature of the associated nerve endings. The result is that the tears in the disc wall close up, stopping the material in the disk from bulging through. This desensitizes the pain sensors that located are in the disc.

HOW THE PROCEDURE IS PERFORMED

Fortunately, IDET therapy is normally an outpatient procedure done with local anesthesia applied at the site of the herniated disc. In order to reduce any discomfort during the procedure, mild sedation may be used. But the physician needs the patient to be awake and aware enough to provide feedback during the procedure. The procedure itself normally takes no more than 20 minutes when only one disc is being treated.

The physician uses X-ray images to guide him while the needle is being inserted into the disc. Once the needle is in, a catheter is passed through it. When the catheter is in place, the heating portion of it will be gradually heated in order to raise the temperature of the disc wall. During this process, the patient’s comfort and condition will be watched carefully because the heating actually reproduces the patient’s lower back pain. This pain is a sign that the heat has been applied to the right spot. At the end of the procedure, the needle and catheter are removed and the patient can go home when any sedation wears off.

Who Needs for IDET?

As it stands, there is absolute method to choose patients to have this procedure. However, the FDA does specifically state that IDET is “intended for solidifying and the decompression of disc material” and that it can be used to “treat patients annular ring disruption of a contained bulge”. It is very important that IDET be used only on patients with the type of disc problems described above. It does not work on problems within any other parts of the spine like joints are nerve roots.

There are some criteria for accepting patients for this procedure that include:

· The patient must have had low back disc pain that has limited function for at least six months. The patient must have gone through other typical treatments like exercise, corticosteroid injections, physical therapy, modification of activity, and use of anti-inflammatory and all of these treatments must have proven unsuccessful.

· There must have had a normal neurological exam.

· Both an SLR exam that is negative and an MRI scan that doesn’t show nerve compression must have been performed.

· The results of a discogram must be positive.

See the chapter called What Test Needs To Be Perform For Back And Neck Pain? for more information on these tests.

People who are approved for this procedure will be happy to know that not only is it much less invasive than disc fusion surgery, it is quite a bit cheaper. The total cost of an IDET procedure is around $8,000 while the surgery is approximately $45,000.

Pain Can Linger as a Result

Before choosing to undergo an IDET procedure, it is important to understand what happens afterwards. The results of IDET are not immediate. Your back pain may actually increase for a while because of the procedure. The heat that was generated can take several days to diminish. You will likely be given pain medication to get you through this period. After about two weeks, the pain should return to the level it was before the procedure.

The pain should start to decrease over the following six to nine months. Undue stress should not be put on the disc that was treated and you should strictly follow the activity and rehabilitation instructions provided by the physician. This home therapy usually includes:

· Walking and mild stretches
· Restrictions on lifting, and bending, sitting
· The use of a back support during the first month after the procedure

By the second and third month you will be instructed to start including floor exercises. The lifting limits will be lifted but bending is still off limits. More active things like golf, skiing, and running will be restricted for the first five months.

IDET is not a sure thing. Some patients do not get relief from their pain and in others the pain may return at some point.

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