What Is Intradiscal Electrothermal Therapy?Intradiscal electrothermal therapy is a fairly new procedure that is minimally invasive. It is performed on patients who suffer from chronic discogenic back pain. Discogenic back pain is believed to be the result of intervertebral disc degeneration. According to a study published in Techniques in Regional Anesthesia & Pain Management, discogenic pain is responsible for between 28% and 43% of back pain cases in the United States. Furthermore, additional studies have supported the fact that discogenic pain is one of the leading causes of low back pain in the U.S.
Many patients suffering with discogenic back pain respond to conventional treatment options including non-steroidal anti-inflammatory drugs (NSAIDs), exercise, and physical therapy; however, there are some patients who fail to respond to these treatment methods. Unfortunately, there are not many treatments available for patients between these conventional methods and surgery. However, intradiscal electrothermal therapy is a relatively conservative treatment method that can be offered to patients instead of surgery.
Intradiscal electrothermal therapy was first introduced in 1997 and utilizes a heated thermal coil, inserted through a catheter to destroy pain-receiving nerves in the intervertebral disc. Heating the inside of the disc causes the tissues to shrink and also cauterizes the small nerve fibers on the periphery of the disc, helping to reduce pain.
How Is Intradiscal Electrothermal Therapy Performed?If sedation is needed for the procedure, an intravenous line is started to deliver the appropriate medication. Vital signs, including heart rate, respiration rate, and blood pressure are monitored throughout the procedure. Before the procedure is initiated, the patient is placed in a prone position on an X-ray table. The skin is then sterilized and prepared for the injection.
Once the skin is infiltrated with a located anesthetic, the physician will insert a 17G needle into the disc using fluoroscopic guidance. Once the needle is positioned properly in the nuclear cavity of the disc, a thermal catheter is inserted through to the disc. Once the catheter is in the proper position on the outer annulus fibrosis, it is gradually heated to 194 degrees Fahrenheit. After the procedure is complete, a bandage is placed over the injection site. The procedure takes less than an hour to complete.
Recovery following intradiscal electrothermal therapy is gradual and patients must be informed of this. Patients may experience an increase in pain for the first seven days after the procedure. Significant pain relief may take eight to 12 weeks and the full effect of the procedure peaks at about four months. During the recovery period, patients must limit physical activity and follow a structured rehabilitation program. Athletic activities should not be resumed until six months after the procedure.
Intradiscal electrothermal therapy is considered a safe and conservative treatment method; however, there are some risks involved with this procedure, including bleeding, infection, nerve damage, and intervertebral disc damage.
Conditions Related To Intradiscal Electrothermal TherapyPatients who have had magnetic resonance imaging or discography that revealed intervertebral disc degeneration or disc herniation are ideal candidates for intradiscal electrothermal therapy. Intervertebral discs are located in the spine and they act as shock absorbers and provide cushioning for the vertebrae. Degeneration of these discs can lead to chronic lumbar spine pain. Additionally, degenerative disc disease and trauma can lead to disc herniation, which can also lead to chronic spinal pain.
An intervertebral disc is made up of two layers: an inner, jelly-like layer (nucleus pulposus), and an outer, fibrous layer (annulus fibrosis). When the outer layer weakens, it allows the inner layer to protrude out, which can cause an irritation of the surrounding spinal nerves. Pain can be felt in the area of the affected intervertebral disc and nerve damage can result in numbness, tingling, and pain in the extremities.
Intradiscal electrothermal therapy helps to seal annular tears that are in the collagen disc covering. Additionally, it helps to thicken the outer shell, thereby destroying the nerve receptors. Some studies have shown that in addition to helping seal annular tears and thicken the outer layer of the intervertebral disc, heating the disc space may also help to decrease pressure in between the intervertebral discs. Destroying the nerve fibers and decreasing intervertebral disc pressure can help to reduce pain in patients suffering from chronic spinal pain.
Patients who experience the following symptoms are the most likely to benefit from intradiscal electrothermal therapy:
- Chronic pain lasting from three to six months
- Failure to respond to conservative treatment methods over the course of at least six weeks
- Disc height of less than 50%
- Disc herniation that is contained
- Disc pain that has been confirmed through MRI or discography
A considerable amount of research has been conducted to investigate the benefits of intradiscal electrothermal therapy for individuals suffering from chronic back pain. The results have been positive and supportive for the use of this therapy for patients’ suffering with discogenic pain. In particular, a study published in the Spine Journal in 2010 found that over 86% of patients undergoing intradiscal electrothermal therapy reported pain relief within one week following the procedure.
An important point to remember is that patients who are smokers are less likely to respond to intradiscal electrothermal therapy. This is due to the fact that smokers have an impaired healing process and smoking has a negative impact on annular collagen tissue.
ConclusionIntradiscal electrothermal therapy is a relatively conservative treatment option that is available to patients who suffer from discogenic pain that has failed to respond to traditional treatment methods. Various research studies have investigated the safety and efficacy of this procedure and have shown positive results for the utilization of this procedure in patients suffering from discogenic pain. Patients suffering from discogenic back pain are encouraged to speak with their physicians regarding intradiscal electrothermal therapy if they suffer from discogenic pain that is unresponsive to traditional pain management therapies.
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- 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.
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