Intradiscal Electro-Thermal Therapy (IDET)

The Institute for Low Back and Neck Care has maintained a long history as a national leader in American spine care. We are continually in search of opportunities to advance the care provided to our patients seeking relief from their back pain. We believe Intradiscal ElectroThermal Therapy (IDET) can be of significant value as an minimally invasive treatment if patients are carefully selected.

Please review this information and if you feel that this treatment modality might be of benefit to you feel free to contact us to request further information, set up an outpatient appointment, or register through our home page.

INTRADISCAL ELECTROTHERMAL THERAPY

As noted in the March 15, 1999 issue of Newsweek magazine Intradiscal ElectroThermal Therapy (IDET) is a new addition to the choices for minimally invasive therapy available to physicians for the treatment of patients with discogenic pain. IDET provides a new outpatient therapy for patients who either would not be recommended for, or would choose other treatments. The IDET procedure is typically used to treat patients who have symptoms from annular tears of the disc as well as small disc herniations producing "discogenic" back pain.

The use of electrothermal therapy is well established in spine care. Percutaneous radiofrequency facet denervations (treating pain related to the facet joints) have now been standard therapeutic modalities at Spine Centers for over 25 years. The IDET intradiscal catheter delivers thermal energy directly to the outer disc wall (annulus) and inner disc contents (nucleus) via a heating coil. It is designed to do three things: destroy the pain receptors in the disc, change the structure of the disc material, and to cauterize the new pain receptor nerve fibers and blood vessels that have grown into the degenerated discs.

The steerable catheter design allows for precise intradiscal placement. Performed under light sedation, the catheter is inserted through a needle and is positioned under x-ray guidance. The procedure is significantly less invasive than open disc surgery and is no more invasive than a discogram.

In addition to an effect on small pain nerve fibers IDET appears to also have an effect on collagen. Collagen is the tissue that joints, tendons, ligaments, and disc walls are made of. The use of the heat to contract or shrink collagen and treat joints that have become loose, such as the shoulder is commonplace. Application of heat at the proper temperature breaks the bonds between the collage fibers. This accomplishes two things: The fibers collapse upon themselves and take up less room, decreasing the pressure inside the disc (average volume reduction is 13%.) As the fibers heal, they shrink and tighten. The tightening of the wall fibers may also help to stabilize a dysfunctional interspace.

Not everyone is a candidate for IDET. IDET is an addition to the minimally invasive therapy armamentarium which includes:

• Acupuncture
• Injections and Blocks
• Radiofrequency Blocks
• Selective Nerve Injections
• Laser Coagulation
• Chemonucleolysis
• Arthroscopic Microsurgial Discectomy AMD

The following problems are typically considered to be possible IDET candidates:

• Back pain and referral leg pain due to an internally disrupted disc with an annular tear or a small contained disc herniation.
• Young patients with preserved disc height and annular tears who have not responded to non-invasive therapy.
• Patients with discogenic pain above or below a previous fusion or multi-level disc pathology who have not responded to less invasive therapy.

Who Is Unlikely To Benefit

• Patients with nerve compression producing neurologic problems due to stenosis, contained or non-contained disc herniations.
• All patients being considered for the IDET procedure should have a thorough neurologic and physical examination and appropriate diagnostic studies. Often discography is helpful in determining candidacy.

Example: Good Potential IDET Candidate A typical case is that of a 40 year old nurse experiencing low back and bilateral leg pain which had not improved with:

• Physical Therapy
• Massage
• Trochanteric Injections
• Facet Injections
• Daily Health Maintenance Program

Discography performed at three levels was normal at L3-4 and at L5-1 (as shown). At L4-5 there was a painful posterior annular tear. IDET coagulation is reasonable as the next step in this patient's treatment plan.

Summary:
IDET continues to be a promising minimally invasive procedure which still requires more in the way of outcomes data documentation. IDET, as discography, is a minimally invasive and a minimally risky procedure. ßIDET is much more expensive. Typically an IDET procedure costs $6000-8,000. Complications such as discitis are possible with both procedures. The long-term (after 2-5 years) maintenance of good results with IDET is also not known at this point in time.