What is IntraDiscal Electrothermal Therapy?
IntraDiscal Electrothermal Therapy (IDET) is a modern technique for the treatment of back pain originating from the intervertebral discs. IntraDiscal Electrothermal Therapy essentially is inserting a probe into the painful disc and applying heat through a catheter in the disc. This local effect causes the collagen component of the disc to thicken and change form, therefore destroying painful nerves located nearby the disc (Wang 2005).
Understanding the anatomy of the back is the key in evaluating a person with back pain. The spine is positioned so that individual vertebrae (bones of the spine) provide a flexible support structure while also protecting the spinal cord. Separating each individual vertebrae are discs that act as cushions to minimize the impact that the spinal column receives. The discs are designed to provide support, but are not as firm as the surrounding bone. The discs have a tendency to herniate backwards through the outer segment and can cause irritation to adjacent nerves. Discs are made of concentric layers of collagen (like the layers in an onion). The layers can tear and disc material can leak outside of the disk causing nerve irritation. Small pain fibers can grow inside of discs and cause pain with everyday activities. Disk disease is one of the most common causes of chronic back pain and accounts for approximately 10% of all low back pain complaints.
IntraDiscal Electrothermal Therapy Procedure
In IntraDiscal Electrothermal Annuloplasty, your pain physician uses an innovative technology to generate heat in order to destroy the painful nerves that are causing your pain. The entire procedure is done under a local anesthetic (numbing agent) and a sedative. Your pain physician will inject a local anesthetic with a small needle to numb the area first. Once the area is numb, a larger needle is placed in the affected disc and a catheter is advanced around the inside of the disc using x-ray guidance.
The entire procedure takes less than an hour to complete and is done as an outpatient procedure. Upon completion, the catheter and needle are removed and a Band-Aid is placed over the needle insertion site.
IntraDiscal Electrothermal Therapy Benefits
Discogenic pain (pain caused by the disc) is a common cause of back pain. IntraDiscal Electrothermal Therapy has several advantages for the treatment of discogenic pain. It is a minimally invasive procedure with high success rates. No hospitalization is required and the procedure is performed under local anesthetic rather than general anesthetic. There is little post-procedure discomfort and you are able to quickly resume your normal activities. Another advantage to IDET is that the area treated is controlled, minimizing the risk of damaging adjacent structures. Often the procedure will provide prolong relief of pain, but if the pain recurs, this minimally invasive treatment may be repeated as many times as necessary.
IntraDiscal Electrothermal Therapy Risks
As with all medications and surgical procedures, there is always a risk of complications. With a minimal amount of risks, IntraDiscal Electrothermal Therapy is considered an appropriate treatment for many patients who suffer from back pain. The most common complaint is mild irritation at the needle insertion site after the procedure anesthetic has worn off. Other more serious and far less common complications include, bleeding, nerve damage, or infection. Many of these risks are decreased with the use of sterile technique, being off blood-thinning medications, and x-ray guidance during the procedure.
IntraDiscal Electrothermal Therapy Outcomes
Although there are many surgical and interventional options for back pain, the most commonly recommended methods are conservative. These methods include interventional procedures, medications, physical therapy, cognitive behavioral therapy, biofeedback, diet, exercise, and alternative techniques (Manchikanti 2007). Often, the pain does not respond to conservative treatments and more advanced interventions like the IntraDiscal Electrothermal Therapy are required to control pain.
In a large study, the outcomes of multiple research trials evaluating the effectiveness of IntraDiscal Electrothermal Therapy were compared. The patients that were studied all had low back pain of at least 3 months duration and had failed conservative care. Every study suggested a positive outcome for the patients who had IntraDiscal Electrothermal Therapy treatment. These patients demonstrated an increase in physical function and decreased levels of pain. The study concluded that pain resulting from disc disease may, not only be reduced, but be diminished by IDET (Wetzel 2002). This is an extremely important concept for people dealing with chronic back pain and more specifically discogenic pain. IDET has shown to not only provide a temporary pain relief solution, but it can cease the pain from returning.
- 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.
- Intradiscal electrothermal therapy used to manage chronic discogenic low back pain: new directions and interventions. Wetzel FT, McNally TA, Phillips FM.Spine. 2002 Nov 15;27(22):2621-6