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Intradiscal Electrothermal Therapy (IDET) |
The Evolution of IDETLow back pain occurs in about 90% of all people at some time in their lives! Incapacitating cases of back and leg pain may lead to stress and financial hardship. Despite the "miracles" of modern medicine, simple and effective solutions to this very common problem have been elusive. One problem in understanding "low back pain" is that it describes a symptom not a specific disease. We are beginning to realize that low back pain can be the result of many different physical problems. Our challenge is to determine the source(s) of spine pain and to develop specific effective treatments. This process can be complicated and is not always successful. It is becoming clear that chronic low back and leg pain is often the result of damage to discs. This is termed "discogenic" pain and can occur without the herniation or rupture that many people identify with disc problems. Discs are complex rubber-like structures between the bones of the spine. They are particularly prone to "wear and tear" damage or may be injured in an accident. Both types of disc injury can result in tears of the outer wall of the disc. These tears may be painful. We do not yet understand why some people develop painful tears and others do not. It appears that damaged discs may become painful due to the irritation of small nerves in the damaged outer wall of the disc or due to irritation and pressure on nerves that grow into the disc with scar tissue. A solution to this pain would be to strengthen the torn, weakened disc wall and to deaden the painful nerves.
The history of a patient's pain, their physical exam, x-rays and MRI scans can suggest the presence of painful damaged discs. Confirmation is provided by a diagnostic disc injection test - also called a discogram. This involves the placement of a thin needle into the disc using an X-Ray machine followed by the injection of contrast dye. The contrast fills disc tears if present. Pressure inside the disc may trigger discomfort if the disc is sensitive. Undamaged discs are not usually painful.
Some patients with very bothersome back problems - including discogenic pain - respond well to medications, therapy, manipulation, injections, or other types of simple treatment. These methods should always be pursued first for spine pain problems. If a person has intolerable pain, has failed reasonable attempts at simple treatment, and has the diagnostic studies that support disc related pain in a limited area of the spine, more aggressive treatment may be an option. Fusion surgery may be considered for severe discogenic pain and although controversial, this remains the most usual treatment. This is done in several ways - all involve making the bones on each side of the treated disc grow together in an attempt to relieve stress on the painful disc. Unfortunately, fusion surgeries can fail to relieve pain for uncertain reasons - probably because the irritated disc somehow continues to be stressed. Newer surgeries remove more of the disc and use metal struts or cages to relieve stress. This is more successful (up to 90% in some studies) but is a substantial, costly surgery with small but potentially serious risks. There may be some patients that have isolated disc damage but should not have spine surgery because of complex problems that will not predictably respond to this type of surgical intervention. Well selected patients may be improved remarkably by surgery. The newest option to treat patients with certain types of disc pain is Intradiscal Electrothermal Therapy - the "IDET" procedure. This involves passing a flexible catheter through a needle into the painful disc. Wires inside the catheter then heat the disc wall resulting in toughening as well as desensitization of the disc.
Coupled with a specific rehabilitation program, 60 to 80 % of patients have achieved significant pain relief. Early results in our practice have been consistent with this success rate. It appears that the most "ideal" patient for this type of procedure has one or two damaged discs. Only recently have patients with more than two damaged, painful discs been treated using this technique. Findings on diagnostic disc injection should reveal a limited area of damage to a generally healthy disc annulus - the outer cartilage wall of the disc. Pressure measurements during the diagnostic disc injection should be taken since discs that respond best to IDET are painful at low injection pressures. This indicates a highly irritated, sensitive disc. As with all spine interventions, successful treatment is not as predictable in patients with severe coexisting psychological disorders. The success of the treatment is also dependent on locating the catheter across the area of damage so that this region of the painful disc wall can be adequately treated. It must be stressed that the positive response to the IDET procedure seems primarily dependent on the post-treatment "healing" or regenerative scarring of the disc wall. Any patient unable or unwilling to commit to the substantial post-procedure activity restrictions and therapy is not a good treatment candidate. Restrictions are as strict as those following fusion surgery. The Day of the IDET ProcedureThe IDET treatment is an outpatient procedure done in our Orthopaedic Surgery Center. On the day of the procedure, nothing but sips of water should be taken by mouth for 4 hours prior to your appointment. You should continue to use your usual medications on the day of your procedure. Only anti-inflammatories or aspirin type medications need to be discontinued 3-4 days before your treatment. When you arrive you will be dressed in a loose gown and shorts we provide. After a brief discussion and physical exam, you will be taken to the procedure room. A small amount of sedative is given by IV to make you comfortable. Usually placing the catheter into the disc is not complicated. Once the catheter is well positioned, each disc treated is slowly and progressively heated for about 17 minutes. After the treatment, you are taken to the recovery room for about I hour. If needed, pain medication will be given by vein or by mouth.
RecoveryFor most people there is a period of mildly increased pain after the procedure lasting a few days or weeks. Pain medication can be used. Physical therapy may be started when post-procedure pain is less marked but usually begins 6-12 weeks following the treatment. Maximal healing following the procedure may take as long as 4 to 6 months. It is most important to limit stress on the heated disc to allow full healing. Very specific physical restrictions are advised. They involve very limited bending and twisting at the waist, minimal lifting, and only short periods of sitting upright. Other than light walking, no specific exercise is allowed until physical therapy is initiated. Activity is then progressed under therapist and physician supervision on an individual basis. People who have sedentary jobs where they can observe activity precautions may return to work in less than a week. Under no circumstances is heavy work or aggressive physical activity allowed until at least six months after the treatment.
There have been no serious complications from the procedure. Long term effectiveness of the treatment is not known because it has only been used since 1997. The procedure is also being used along with surgical fusion in complex spine problems in hope of achieving better total symptom improvement. At this time, our patients have shown very promising results typical to other groups around the country who are providing this treatment. Some have had excellent pain relief almost immediately following the procedure. Others show little immediate benefit. In the long run, we expect at least over 67% of our patients to get at least 50% of their pain relieved. Early follow up studies show sustained relief (>1year) in at least 50% of all those treated. These data compare favorably with the long term results of fusion surgery. With continued refinement of the procedure an d proper patient selection, the percentage of success should rise. Discopathic pain can be a severe chronic problem in some patients and effective care should be sought. At this time, if basic conservative care fails, the only treatment option is aggressive surgery which is costly, potentially dangerous, and compromises spine biomechanics permanently. The IDET procedure offers a less invasive outpatient procedure with a more convenient recovery, costs a fraction of that of a comparable surgical fusion, and is a less radical alteration in spinal anatomy. The hope is that carefully chosen patients will find this procedure as effective and more appealing than surgery. Due to the apparent substantial inherent advantages of this technique when compared to surgery, we believe it should be offered to patients. Objective outcome data must be collected and be made public to responsibly evaluate the long term effectiveness of the procedure. Comparison of these outcomes must be made with both surgical outcomes and with the natural history of the untreated disorder. Unfortunately, there are few good quality scientific studies looking at the true success rates of many of our treatments for spine problems including fusion surgery. The long term success of the IDET procedure remains to be proven but appears promising. We are proud to be one of the first centers in New England to offer this unique treatment option!
Looking for a physician
listing of who performs the IDET procedure in your area?
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| Telephone | Fax | Postal Address | Electronic mail |
| (207) 828-2100 | (207) 828-2190 | 33
Sewall Street Portland, ME 04102 |
info@orthoassociates.com |
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