Intradiscal electrothermal therapy (IDET) holds promise for those who suffer from discogenic low back pain. This type of therapy uses heat delivered directly within the symptomatic discs to shrink collagen fibers and destroy nerves to overcome low back pain.
Studies on IDET have proven the procedure to be effective for appropriate patients, with about 75 percent of those undergoing treatment reporting satisfactory outcomes of reduced pain and increased mobility. IDET is also a cost-effective method for low back pain treatment, especially when compared to pricey spinal fusions.
Age or injury may produce tears or cracks in the walls of intervertebral discs. These tears can become filled with small nerve endings and blood vessels and, for many patients, are the source of chronic pain. In theory, the IDET procedure thickens and strengthens the disc wall by applying controlled heat to the disc wall. This heat lesion also destroys pain-causing nerve fibers within the disc, eliminating pain from that source.
First, a small tube called a catheter is inserted into the disc with fluoroscopic guidance. The catheter is then maneuvered to achieve a 360-degree penetration. Heat is introduced into the disc through the catheter, gradually progressing around 150° F to approximately 200° F. The entire IDET procedure is performed on an outpatient basis and takes approximately one hour, with an additional hour of recovery time.
Some patients report immediate pain relief, but it is more likely that significant relief and improvement in function occurs as the disc heals. This process generally takes four to twelve weeks. Patients typically return to basic work within one week of the procedure. After six weeks, more strenuous physical activity, in combination with a formal spinal-strengthening program, may begin. Patients can be expected to be fully healed six months after the procedure.
Candidates for IDET are those who have chronic discogenic back pain that has not responded to aggressive, non-operative therapy. Usually, patients have been experiencing lumbar pain for at least six months, have had a normal neurologic exam and have undergone an MRI that showed no neural compressive lesion. Discography is essential in confirming that the disc itself is the source of the pain, identifying the number of affected discs and locating tears within the disc(s). IDET is not indicated for severe disc degeneration, nerve compression, spinal instability or spinal stenosis.