Intradiscal electrothermal therapy (IDET)
is a relatively new,
minimally invasive treatment for
spinal disc-related chronic
low back pain. This type of persistent disc pain is
thought to be caused by nerve fibers that have grown from their normal location
in the outer layers of the disc, reaching into the disc interior. This is related to the breakdown (degeneration) of the tough
outer layers (annulus) of the disc. The pain may also be from injury to the
disc, causing the material in the center (nucleus) of the disc to move into the
outer layers of the disc. This material from the nucleus is irritating to the
outer layers, where the nerves are, and it causes pain.
Discography is typically done before IDET to try to
clearly identify the disc problem. After discography, your doctor will decide
whether it is likely that your disc problem can be helped by IDET. Before an
IDET procedure, you are given a
sedative and a
local anesthetic. Using "live" X-ray imaging
(fluoroscopy), a doctor inserts a hollow needle containing a flexible tube
(catheter) and heating element into the spinal disc. The catheter is positioned
in a circle in the outer layer (annulus) of the disc and is then slowly heated
to about 194°F (90°C). The heat
is meant to destroy the nerve fibers and toughen the disc tissue, sealing any
small tears. Antibiotics, either given in a vein (intravenous) or
injected into the disc, are used to prevent a disc infection.
Pain relief after IDET is not
immediate. Pain may increase during the first couple of days. Physical therapy
is a necessary part of recovery. During the first month after IDET, plan to
walk and do easy stretches as prescribed by your doctor. During the first 2 to
3 months, exercise as directed, and avoid lifting, bending, and long periods of
People who have had IDET are usually told to wait at least 5 to 6
months before resuming strenuous sports such as skiing, running, or
IDET is used to treat a select
subgroup of people who have had chronic disc-related low back pain (usually for
at least 3 to 6 months) despite nonsurgical treatment.2, 3 IDET is not recommended for people
who have severe disc degeneration,
spinal stenosis, or spinal instability (such as
Since its introduction in the 1990s, IDET has been evaluated in several small studies. Larger studies have
been hard to do, because most people do not meet the requirements for this
procedure. There is no consistent evidence that this treatment works, and most experts do not recommend it.4
Although complications are rare, possible risks include:
Discography may increase the risk of disc problems in the future.5 If your doctor recommends
discography, experts recommend getting a
second opinion before having the test.
If you are considering IDET, be sure that you are a good candidate
for the procedure and that the doctor doing the procedure is well trained
and experienced. If you are unsure about whether IDET is right for you,
consider getting a
Here are some of the criteria your doctor will use to decide whether you might
be a good candidate for IDET.6
Your health insurance provider may not cover this procedure.
Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.
Saal JA, Saal JS (2002). Intradiscal electrothermal treatment for chronic discogenic low back pain: Prospective outcome study with a minimum 2-year follow-up. Spine, 27(9): 966–974.
Freeman BJC, et al. (2005). A randomized, double-blind, controlled trial: Intradiscal electrothermal therapy versus placebo for the treatment of chronic discogenic low back pain. Spine, 20(21): 2369–2377.
Pauza KJ, et al. (2004). A randomized, placebo-controlled trial of intradiscal electrothermal therapy for the treatment of discogenic low back pain. Spine Journal, 4(1): 27–35.
Chou R, et al. (2009). Interventional therapies, surgery and interdisciplinary rehabilitation for low back pain: An evidence-based clinical practice guideline from the American Pain Society. Spine, 34(10): 1066–1077.
Carragee EJ, et al. (2009). Does discography cause accelerated progression of degeneration changes in the lumbar disc: A ten-year matched cohort study. Spine, 34(21): 2338–2345.
Kloth DS, et al. (2008). Intradiscal electrothermal therapy (IDET) for
the treatment of discogenic low back pain:
Patient selection and indications for use. Pain Physician, 11(5): 659–668.
February 15, 2012
William H. Blahd, Jr., MD, FACEP - Emergency Medicine
& Robert B. Keller, MD - Orthopedics
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