Intradiscal electrothermic therapy (IDET) for low back pain

Surgery Overview

Intradiscal electrothermic 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.¹ 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 causes pain.

Because it is not yet well-researched, IDET is considered an experimental treatment.

Discography is generally done before IDET to try to clearly identify the disc problem. 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 around the inside of the disc, and is then slowly heated to about 194°F (90°C). The heat is meant to kill 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.

See an illustration of intradiscal electrothermic therapy .

What To Expect After Surgery

Pain relief after intradiscal electrothermic therapy (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 sitting.

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 tennis.²

Why It Is Done

Intradiscal electrothermic therapy (IDET) is used to treat a select subgroup of people who have had chronic disc-related low back pain (usually for at least 6 months) despite aggressive nonsurgical treatment.^{2, 1} IDET is not recommended for people with severe disc degeneration, spinal stenosis, or spinal instability (such as spondylolysis).

How Well It Works

Since its introduction in the 1990s, intradiscal electrothermic therapy (IDET) has been evaluated in small studies. Some research has suggested IDET is a safe and effective intermediate treatment.³ Other studies have not shown IDET to be any better than a placebo for easing back pain.^{4, 5} Larger, long-term studies still need to be conducted.

Risks

Complications of intradiscal electrothermic therapy (IDET) are relatively uncommon. In one study of 58 people, no complications were observed.² Another study of 33 people reported 5 (15%) cases of increased nerve root pain after IDET that were successfully treated with epidural corticosteroid injection.¹

Other possible risks include:

• Nerve damage.
• Disc damage.
• Disc infection.

What To Think About

If you are considering IDET, consider getting a second medical opinion to ensure that you are a good candidate for the procedure. Make sure that the doctor performing the procedure is well-trained and experienced.

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.

Author:	Shannon Erstad, MBA/MPH Lila Havens	Last Updated February 15, 2006
Medical Review:	William M. Green, MD - Emergency Medicine Kathleen Romito, MD - Family Medicine Kathie Hummel-Berry, PT, PhD - Physical Therapy Robert B. Keller, MD - Orthopedics
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