IDET therapy is a relatively new technique for the treatment of back pain that originates from the intervertebral discs. IDET essentially is administered by inserting a probe into the irritated disc and applying heat to it through a catheter. This causes the collagen in the disc to thicken and change form, destroying painful nerves located nearby the disc (Wang 2005).
The spine is positioned so that individual vertebrae (bones of the spine) provide a flexible support structure for the spinal cord. Separating individual vertebrae, are discs that act as cushions that absorb the physical impact that the spinal column receives. These are not as firm as the surrounding bone and have a tendency to herniate backwards through the outer segment. This can cause irritation to adjacent nerves. Discs are made of concentric layers of collagen, one on top of the other. Sometimes, the layers tear, and disc material can leak outside of the disk. This causes nerve irritation. Small pain fibers can grow inside discs, causing pain, and even simple everyday activities can become impossible to complete. Disk disease is one of the most common causes of chronic back pain in the world, and it accounts for approximately 10% of all low back pain complaints.
Procedure
The IDET (intradiscal Electro-Thermal) Annuloplasty, is an innovative technology that generates heat in order to destroy the painful nerves that are causing you low back pain. The procedure uses only a local anesthetic (numbing agent) and a sedative. Using a small needle, your pain physician will inject the area with a local anesthetic, first, to numb the area. When numbness is achieved, a larger needle is placed in the affected disc, and a catheter is advanced to the inside of the disc using x-ray guidance.
The procedure lasts less than an hour and is done on an outpatient basis. After the procedure is completed, the catheter and needle are removed and a small bandage is placed over the needle insertion site.
Benefits
Discogenic pain (pain caused by the disc) is an extremely common cause for back pain complaint. IDET therapy has several advantages over other disogenic pain treatments. It is minimally invasive, has a high success rate, requires no hospitalization, and is performed under a local anesthetic rather than general. Additionally, there is hardly any post-procedure discomfort, and normal activities are quickly resumed. Another advantage to IDET is that this is a highly controlled procedure, making the risk of damaging adjacent structures, very slim. Most often, IDET provides immediate, long lasting relief, but if it doesn’t, it can be repeated as many times as are needed to achieve proper pain relief.
Risks
As with all medications and surgical procedures, there is risk. However, the risks presented by IDET are very minimal. It is considered an appropriate treatment for many patients who suffer from back pain. The most common complaint is mild irritation at the needle site after the procedure anesthetic has worn off, as there is with any procedure utilizing needles. Other, more serious and far less common, complications include: Bleeding, nerve damage, or infection. Many of these risks are decreased with proper sterilization, temporarily stopping any blood-thinning medications, and using x-ray guidance during the procedure.
Outcomes
Although there are many surgical, and other, options for back pain, the most commonly recommended methods are conservative ones. These methods include interventional procedures, medications, physical therapy, cognitive behavioral therapy, biofeedback, diet, exercise, and many other alternative techniques and procedures (Manchikanti 2007). Sometimes, a patient’s back pain is so intense and unrelenting, that more advanced interventions like the IDET are required to control pain.
In a large study, patients that had low back pain for, at least, three months, and failed to respond to conservative care, responded well to IDET. The patients demonstrated an increase in physical function and decreased levels of back pain. The study concluded that pain resulting from disc disease may, not only be reduced, but be ended by IDET (Wetzel 2002). This is an extremely encouraging news for people dealing with chronic back pain and, more specifically, disc-related pain. IDET provides, both, temporary and long-term pain relief.
Articles
- Evaluation of Lumbar Facet Joint Nerve Blocks in the Management of Chronic Low Back Pain: Preliminary Report of a Randomized, Double-Blind Controlled Trial: Clinical Trial NCT00355914 Laxmaiah Manchikanti, MD, Kavita N. Manchikanti, BA, Rajeev Manchukonda, BDS, Kimberly A. Cash, RT, Kim S. Damron, RN, Vidyasagar Pampati, MSc, and Carla D. McManus, RN, BSN 2007;10;425-440.
- The effect of uniform heating on the biomechanical properties of the intervertebral disc in a porcine model. Wang JC, Kabo JM, Tsou PM, Halevi L, Shamie AN. Spine J. 2005 Jan-Feb;5(1):64-70.