Intradiscal Electrothermic Therapy (IDET) is a minimally invasive technique that has been around for some time now and is used to treat chronic back pain due to disc-related issues.
Spinal discs act as cushions between adjacent vertebrae that make up the spine. As a person ages, the disks lose the fluid and develop breaks and cracks in the disc wall. When this happens, the blood vessels infiltrate the area in an attempt to repair this damage. Apart from the blood vessels, pain fibres also get within the area and this is why you feel pain.IDET is a relatively recent technique that was approved by the FDA in 1998. The technique was developed to treat pain that originates from spinal disc degeneration and related disorders. Previously, any defect in the spinal disc required urgent surgical intervention, but studies showed that the surgery could cure the issue, but could not improve the pain that the patient suffered from.
IDET was developed and has been improved over the years to reduce pain with less invasive processes, which in turn decreases the risks of complications while improving the rate of recovery as well as expenses.
This procedure is used to treat various conditions including:
- Small spinal disc herniations
- Disc degeneration (mild) that is limited to maximum 2 levels.
- Internal tears in disks.
In order to qualify for the surgery, you should usually have had chronic back pain for at least 3 months.
Goal of IDET
The goals of IDET include:
- To burn the nerves found in the disc’s outer shell with a heated instrument to stop further bleeding or stop infection. This relieves pain associated with degeneration.
- To assist the tears in the disc to close up through thickening of the collagen within the wall of the disc.
The procedure accomplishes this feat through the application of heat to the disc, a procedure discussed below.
How Does IDET Work?
1. Pre-surgical Preparation
Discography is done before the procedure to make sure the problem is clearly identified. After discography, your physician will decide whether the problem can be helped by IDET.
This usually happens a week before the surgical procedure. First, the patient has to stop taking some prescribed drugs that might make the procedure unsuccessful. Top on this list is aspirin and its compounds and NSAIDs. However, you can continue taking any prescribed blood pressure, heart or diabetic medications.
Make sure you let your physician if you have a bleeding disorder or if you are taking blood thinners. You also need to tell your doctor if you are allergic to iodine or if you have any illness that isn’t treated yet.
On the day of the procedure, make sure to fast; though your surgeon might allow for soup, juice or broth (be sure to ask).
On top of everything, you need to have someone to drive you home after the procedure.
2. The Procedure
This procedure takes roughly an hour, but it has a success rate of between 60 and 75 percent among patients.
You get a mild sedative via an IV line. The doctor uses fluoroscopy where a hollow needle is inserted into the disc. The physician then inserts an electrothermal catheter or a heating wire through the needle, after which it is positioned in the disc specifically where the issue is.
The wire is then heated gradually to 194 degrees Fahrenheit (90 degrees Celsius) for between 15 and 20 minutes. This heat causes the walls of the disc to thicken and heal any small tears as it destroys any nerve endings that are within the area.
The physician then gives you antibiotics through the IV line into the disc to prevent infection. After this, the needle is removed and a sterile dressing applied to the area. You are then transferred to the recovery area until you are ready to go home.
The area might feel numb and sore for 1-2 days after the procedure; the physician might prescribe physical therapy. During the recovery phase, minimize sitting and bending for long periods of time. Depending on the circumstances, the physician might prescribe lumbar support for up to 8 weeks. Walks and easy stretches are also a good way to heal faster. Avoid activities such as running, swimming or tennis.
You might start feeling improvements from 6 to 8 weeks.
Apart from the soreness that goes away in a short while, other complications are rare but the possible risks include disc damage, spine weakness, disc infection and nerve damage.
Though the procedure has promise, there is no consistent evidence that this treatment works, and most experts don’t recommend it at this time.
References and Further Reading
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