IntraDiscal ElectroThermal Therapy (IDET)
Problems in the spine can develop following injury or as a result of aging and disc degeneration. Small cracks or fissures may occur in the wall of the disc and cause pain centered in your neck or lower back. Large tears can result in herniation of the disc and pain radiating into your arms or legs.
Symptoms can often be improved simply with time, rest and common medicines such as aspirin or Advil. Sometimes more powerful treatment such as an epidural or facet joint cortisone injection is needed to obtain pain relief. Exercises often under the supervision of a physical therapist may be started and hopefully allow you to return to full activity. If however routine treatments are unsuccessful your doctor may recommend further testing to obtain a clear picture of what is causing the pain and to assist in planning further treatment. This could include X-rays, an MRI, a CT/myelogram, a bone scan and/or a discogram.
If your symptoms persist and the pain and limitations are intolerable surgery may be considered. Several types of spinal surgery are routinely recommended. Laminectomy and discectomy are commonly performed to treat disc herniation, pinched nerves and spinal stenosis. Spinal fusion is used to strengthen the spine or treat severely damaged or degenerated discs. IntraDiscal ElectroThermal Therapy (IDET) is a new procedure developed to treat small tears or fissures in the disc and some small disc herniations before they go on to severe degeneration.
(IDET) is a minimally invasive, out-patient procedure developed in 1998 that uses heat to treat certain types of disc injuries. An X-ray machine called a fluoroscope or C-Arm is used to place a specially designed catheter (a thin tube) into the damaged portion of the disc thorough a needle. The tip of the catheter applies a carefully measured amount of heat to the disc which causes the collagen (a major protein in the disc) to thicken, shrink and strengthen. It also coagulates and desensitizes the pain sensors within the disc. 60-75% of patients in the initial studies have reported satisfactory pain relief one year after the procedure. The long-term results are unknown. Not all disc problems can be treated with IDET. Patients with a large disc herniation, spinal stenosis or advanced disc degeneration are not candidates for treatment. A complete diagnostic evaluation is required to determine if you will benefit from IDET.
You should not have anything to eat or drink for at least 8 hours prior to IDET, because you may be receiving intravenous sedation during the procedure. Please bring with you any X-ray studies you have at home. After registering, a nurse will complete preparations for the procedure. In the procedure room you will be positioned on the table on your stomach. After your skin is cleaned with iodine and is numbed with local anesthesia the needle and catheter will be inserted into the disc. The fluoroscope machine is used to guide exact placement. The disc is then slowly heated to the correct temperature. This usually takes about 17 minutes. While the disc is heating you may experience an increase in your typical pain. You will be given additional medication if needed. Often the entire disc can be treated through one needle. Sometimes a second needle inserted from the opposite side is needed to permit treatment of the entire disc. If two discs need to be treated the procedure is then repeated at the second level. At the completion of the procedure you will be monitored until stable. After the sedative medication has worn off, discharge instructions are reviewed. A friend or relative must be with you or available to bring you home. Driving is prohibited. If you have been fit with a spinal brace, bring it with you to the procedure so that you may wear it home.
AFTER THE PROCEDURE
The discomfort generated when the disc is heated may take several days to subside. It can be treated with rest in bed, an ice pack and/or Tylenol or Advil. Your doctor may choose to give you a stronger pain medication or muscle relaxant if appropriate. Occasionally a short course of oral cortisone can be helpful to control post-procedure discomfort. A back support or brace is used at all times when out of bed after the procedure until sufficient healing has occurred (usually about 6 weeks). Disc healing will continue for 3-4 months after IDET. You should not overexert yourself during this time, even if you experience a marked reduction in your usual pre-procedure pain.
During the first month after IDET you should restrict bending twisting or heavy lifting. No strenuous housework, gym workouts or sports activities such as running, biking, golfing, tennis, or skiing, etc. are allowed. Limit your sitting time to tolerance levels and limit long car rides or airplane flights to only what is absolutely necessary. You do not have to abstain from sexual activity, but be careful not to exert your back. You should discuss your plan to return to work with your doctor. If your work is sedentary, you can typically return within one week after the procedure.
Rehabilitation exercises will begin in the second month after IDET. The physical therapist will instruct you in proper body mechanics and lifting technique and will begin an exercise program designed to improve your strength and flexibility. If you have been performing strenuous exercises before the procedure you will not return to that level of exercise but to a more moderate level that will be gradually increased as you improve. If you plan to return to strenuous work or sports special advanced training will probably help you achieve this goal. Improvements may continue for up to six months following the procedure.
RISKS AND SIDE EFFECTS
There are a few potential risks and side effects which you should understand. Infection in the disc can occur. You will be given antibiotics prior to the procedure to minimize this risk. Bleeding and nerve damage have been reported but are very rare. Because you are awake during IDET your doctor can carefully monitor your neurologic status during needle placement and disc heating. Not all patients will find relief of their pain and symptoms may recur over time.
POST IDET INSTRUCTIONS
- In the first week after the procedure you may experience a moderate increase in your normal pain. Rest, ice, pain medications and anti-inflammatory medication will minimize discomfort during this time.
- Restrict your activities as described above. Use your brace when out of bed if advised.
- Any unusual or new symptoms (for example, fever, weakness, numbness, or a change in your bowel or bladder function) should be reported to your physician immediately, or you should contact the emergency room for further evaluation.
- Call your doctor’s office for a follow up appointment in several weeks.