What is IDET or Intradiscal Electrothermal Therapy?
IDET Procedure or Intradiscal Electrothermal Therapy means surgical treatment of the intervertebral disc having cracks or fissures by thermal manipulation of the collagen of the disc, whereby heating the collagen and allowing it to remodel or heal to restore the functional integrity of the disc. The internal disc disruption causes the spine to get compressed and thus causing chronic pain in the lower back. IDET is a new procedure for discogenic back pain.
In IDET procedure, the physician applies controlled heat to the affected disc wall. Heat contracts and thickens the disc material resulting in contraction of the disc wall thus reduction in the bulge of inner disc material.
Indication for IDET Procedure
Internal disc disruption is characterized by degradation of the nucleus pulposus of the affected disc. Heat contracts and thickens the disc material resulting in contraction of the disc wall tears. IDET is indicated in patients with chronic back pain that does not respond to conservative treatments like medications, rest, activity modifications, physical therapy or appropriate exercise program. Majority of the patients get relief by the above mentioned treatments.
For those who don’t respond to the above-mentioned treatments and have significant pain to limit their daily activities, different diagnostic tests are suggested. These include MRI and lumbar discography.
IDET Procedure: How is Intradiscal Electrothermal Therapy Done?
The IDET treatment was first introduced in 1997 and has been performed extensively since then. It can be performed in at multiple disc levels. Once the symptomatic disc or discs have been identified, the patient is brought to the procedure suite and placed face down on the operative table. Intravenous sedation is usually given to relax the patient and relieve any discomfort during the IDET procedure. A flexible catheter is inserted into the target disc under x-ray guidance and navigated into the proper position. The terminal portion of the catheter is placed along the posterior disc wall to the level of the painful area, and then slowly heated to 90 degrees Celsius for 15 to 16 minutes. The catheter is then removed and the disc is injected with a small amount of antibiotic and anesthetic medication to lessen discomfort and the risk of infection. If the catheter cannot be fully advanced along the entire posterior disc wall, the thermal treatment is performed and then a second catheter is inserted from the opposite side and a second thermal treatment is carried out.
Once the IDET procedure is completed you will likely be sent home with a Band-Aid over the needle insertion site.
Recovery Period Following IDET Procedure
The patient having undergone IDET procedure will not experience instant relief from the pain but there is a significant relief after a period of about few months.
Discomfort from the disc being heated during IDET procedure may take several days to subside, and your physician may prescribe medication. Your disc will heal in the 8 to 16 weeks following the IDET procedure. During this time, it is very important to refrain yourself from any type of physical stress like lifting, bending, stretching, prolonged sitting or standing. Your physician may prescribe temporary lumbar support as well as activity and physical rehabilitation guidelines. Patients who undrgo IDET procedure report that during this healing time they begin to experience relief from their lower back pain symptoms, decreased or eliminate medication use, and increase their functional abilities.
Contraindications and Risks of IDET
There are some factors that are associated with the poor outcome of the IDET surgery or Intradiscal Electrothermal Therapy. Some of these factors are obesity, significant narrowing of the disc space, diffuse disc degeneration, three or more symptomatic discs, large disc herniations, spinal instability etc.
Like any other surgical procedure, IDET or Intradiscal Electrothermal Therapy has some associated risks. Not all patients will find relief from their back pain and discomfort. There are minimal risks associated with IDET when it is performed by an experienced physician. Most published studies of IDET therapy have not reported any significant complications and the real risk of complications are now felt to be quite low.
IDET procedure or Intradiscal Electrothermal Therapy has been established as a safe and minimally invasive treatment that may provide relief to a selected group of patients with painful disc disorders without the risks of major spinal surgeries. Careful patient selection and meticulous placement of the IDET catheter appear to lead to higher success rates in providing pain relief for patients. Most of the patients who have undergone this surgery report an increased activity level and improvement in sitting for comparatively longer period of time.
Finally, the operating doctor must carefully select the patient and make sure that he or she is a good candidate for IDET.