What is Intradiscal Electrothermal Therapy?
Intradiscal electrothermal therapy explained by Denver, Golden, Aurora, Boulder, Broomfield, Jefferson, and Littleton Colorado’s top pain doctors
Intradiscal electrothermal therapy (IDET) is a minimally invasive treatment for patients suffering from disc problems that cause chronic lower back pain. The abnormal growth of nerve fibers in the disc can lead to chronic pain and weakening of the disc.
Common causes of disc herniation and associated disc pain are degenerative disc disease and traumatic injury, such as a fall. It is estimated that discogenic pain is responsible for over one third of all cases of back pain, therefore, an effective, non-invasive treatment option is critical. This treatment eliminates the excess nerve fibers and strengthens the disc by a heat treatment of the affected area.
How is Intradiscal Electrothermal Therapy Performed?
The entire treatment typically takes less than an hour. To prepare for intradiscal electrothermal therapy, the patient is placed face-down and the skin on the back near the site of treatment is sterilized. A sedative and local anesthetic are then administered. The catheter for this procedure is combined with a small heating element. The catheter and heating element, guided by fluoroscopic imaging, is inserted next to the outer layer (annulus fibrosus) of the causative disc. The heating element is then warmed to 194°F to destroy the excess nerve fibers and strengthen the disc by thickening the collagen fibers that it is comprised of.
Physical therapy is used to aid recovery of IDET patients. During the first few months after treatment, light exercise such as stretching and walking are recommended. Strenuous activity such as running should be avoided during the recovery period of several months until the patient is cleared by their doctor.
Despite the relative safety of this procedure, the patient should be aware of potential side effects and complications. Although complications from intradiscal electrothermal therapy are rare, they include bleeding, infection, disc damage, and nerve damage.
Conditions Related to Intradiscal Electrothermal Therapy
Patients undergo a discography of the spinal disc to determine the specific problem and whether intradiscal electrothermal therapy is the best option. Discography is an MRI procedure to determine the severity of herniation or degeneration of the disc. The discs provide a cushion between vertebrae and can become damaged due to injury or degeneration.
When the covering of the disc (the annulus fibrosus) weakens, the jelly-like inner part of the disc (nucleus) may begin to leak out causing a herniated disc, also referred to as a slipped disc. The bulging of these nerve fibers beyond their normal position can lead to nerve damage and pain. When this damage occurs in the lumbar area of the spine (in the lower back), then pain, numbness, or a tingling sensation may be felt in the legs and feet. When this damage is in the cervical area of the spine (in the neck), these sensations may be felt in the arms and hands.
The pain of a herniated disc may be so severe as to limit everyday function of the patient. Initial attempts to relieve pain include oral medications and light exercise. When oral medication is not adequate to manage this pain, intradiscal electrothermal therapy can be used as a more permanent solution.
Patients experiencing the most relief from this procedure have discogenic pain confirmed by imaging, disc herniations protruding less than 4 mm, more than 50% loss of disc height, and pain lasting for three to six months without relief from oral medications and exercise. This procedure is less effective in patients who smoke or have severe disc degeneration.
Intradiscal electrothermal therapy for sufferers of chronic back pain has been the subject of several studies. A study published in Spine Journal in 2010 reported that, in patients suffering from discogenic pain, 86% experienced pain relief within one week following the procedure. This study is not alone in these findings. Intradiscal electrothermal therapy has been determined to be safe and effective in several studies and follow-up investigations.
Intradiscal electrothermal therapy is a viable solution for patient’s suffering from severe chronic lower back pain. It is minimally invasive, low risk, provides benefits within a few days, and can be performed as an outpatient procedure. Recovery includes physical therapy and may take up to five or six months.
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- Maurer P, Block JE, Squillante D. Intradiscal electrothermal therapy (IDET) provides effective symptom relief in patients with discogenic low back pain. J Spinal Discord Tech. 2008; 21(1):55-62.
- Ksi-Kai T, Shao-Chiang C, Ting-Hsien Y, Jin-Jean H, Horng-Chaung H. Ontradiscal electrothermal therapy in the treatment of chronic low back pain: experience with 93 patients. Spine J. 2010; 1(1):37-44.