Intra-Discal Electrothermal Therapy-IDET
What Is an IDET (Intra-Discal Electrothermal Therapy)
A relatively new treatment for back pain resulting from problems within the cushioning discs is intradiscal electrothermal annuloplasty, also called intradiscal electrothermal therapy (IDET). This outpatient procedure, applies high heat directly to the inside of the disc. Different mechanism of action, have been postulated to explain how the IDET works. It can destroy the small nerve endings in the posterior wall of the disc (annulus) responsible for pain transmission. The high heat can produce several changes in the protein matrix in the nucleus (gel inside the disc) decreasing the ongoing inflammatory process. Last, it can potentially help sealed the tears in the annulus (fibrous outer wall) of the disc.
Who Is a Candidate for an IDET?
Patients suffering from mainly low back pain, due to a painful disc, which failed conservative therapy including but not limited to: physical therapy, chiropractic care, medication management and injections. The diagnosis and identification of a specific disc as the source of pain, is achieved by a diagnostic test called discography. If the patients symptoms are mainly low back pain, buttock and occasionally referred leg pain. Patients must have a significant amount of disc space present (at least 50 % or original level) and no evidence of neurological deficits.
Usually the procedure is performed under intravenous sedation with local anesthetic supplementation. Oral medications are also available to assist with relaxation before and during the procedure. You will be taken to the procedure suite, place in the fluoroscopy bed lying on your stomach. Blood pressure and cardiac monitors will be applied. Next, your lower back area will be scrub and cleansed in a sterile fashion. With the aid of an X-ray guidance, which provides constant imaging (called fluoroscopy), the inter- vertebral discs are identified. The physician will then inject a small amount of local anesthetic in the skin and deeper tissues to numb the area. This may be associated with mild and brief stinging sensations. Once the area is numb, your doctor will insert a special needle into the appropriate disc nucleus, under x-ray guidance. A small amount of contrast (X-ray dye) will be injected to confirm proper needle placement. Then, the Electro-Thermal Catheter is inserted and positioned inside the disc in the back wall of the annulus. Proper position is confirmed by X-ray and of the posterior disc wall is performed for approximately 17 minutes, to a maximum of 90 degrees Centigrade. The procedure usually takes about 30 minutes and is associated with minimum post -operative discomfort.
After the Procedure
You will go back to the post anesthesia care unit (if you received intravenous sedation), where you will be monitored for 30-60 minutes according to your response. Post procedure instructions will be given in a pre-printed form. A follow up appointment will be made for post procedure evaluation in approximately one week. Medications prescribed for the post -operative period may include: an antibiotic, a muscle relaxant and an analgesic/anti-inflammatory. The post procedure discomfort is usually minor and can be manage with ice packs and medications.
General Pre and Post Procedure Instructions
If intravenous sedation is planned, avoid eating any king of solid foods prior to the procedure and you may have clear liquids up to 4 hours prior to the procedure. If you are taking Coumadin, Heparin, Plavix or non-steroidal anti-inflamatories (such as aspirin, ketoprofen, naproxen or others), stop taking them at least one week prior to the procedure. If you are diabetic and planning on having IV sedation, our office will give you specific instructions. The decision to return to work after the procedure will be made on an individual basis considering medical necessity and your specific condition.