IDET is the abbreviation for Intradiscal Electrothermal Therapy™. This is a fairly recent technique, FDA approved in 1998, developed for treatment of pain originating from a spinal disc. In the past, severe low back and leg pain caused by a defect in the spinal disc typically required surgery. Surgery frequently can “cure” the problem, but it may not improve the pain. Surgery is also very invasive, not to mention expensive. The IDET procedure was developed and designed with the goal of reducing pain with less invasive techniques, decreasing the risks of complications, and lessening the recovery time and expense.
The IDET procedure is typically used to treat patients who have symptoms from small tears of the discs. The IDET catheter delivers heat directly to the outer wall (annulus) and inner disc contents (nucleus) via heating coil. It is designed to do three things: (1) Destroy the pain receptors in the disc, (2) change the structure of the collagen disc wall “melting the tear”, and (3) cauterize the new pain receptor nerve fibers and blood vessels that have grown into the degenerated discs.
Is this procedure effective?
Yes, the IDET procedure appears to be reasonable and safe for selected patients with chronic low back pain, with a 50% to 80% chance for significant ongoing pain relief.
What is the typical procedure?
Once your provider determines that you are a candidate for IDET therapy, an appointment will be made for you in an outpatient surgery center. You are generally given intravenous medication to help you relax during the procedure. You will be closely watched with an EKG monitor, blood pressure cuff, and blood oxygen monitoring device. During the procedure you will be positioned on your stomach. For comfort, local anesthesia will be given before the procedure begins. Using fluoroscopy (X-ray guidance), a needle is inserted into the disc. Through the needle a flexible catheter is placed into the disc. Once in proper position, this catheter is heated for about 17 minutes. When done, the catheter and needle are removed and a small dressing is placed over the site. You will be monitored for a short time after the procedure and will be able to return home.
What will I feel during the procedure?
During the heating, you may feel a reproduction of your usual back pain. This is an excellent sign that the procedure is having an effect in the correct damaged area.
How long does the procedure take?
One disc typically takes 30-45 minutes, and 2 discs take about 60 minutes.
What are the alternatives to IDET therapy?
If you have disc pain, the alternative treatments are medications, physical therapy, and epidural steroid injections. Your provider is most likely ordering IDET because more conservative therapies have failed. You also have the option of surgical intervention.
What are the risks of IDET?
As with any procedure, there are some inherent risks, although most of these are minimal. Common risks include but are not limited to bruising, bleeding, headaches, irritation of a nerve or nerve injury, including paralysis, numbness and weakness. Risks also include infection or reactions to the medications which may cause breathing difficulties and cardiac difficulties which may lead to death. An infection could require the use of antibiotics and/or surgery. Serious risks and complications are extremely rare, however.
Additionally, if the heating element of the catheter comes too close to a nerve root or is placed in the wrong spot, this could cause injury to a portion of the spinal cord or nerve root. Because of this risk, the procedure is done under fluoroscopic guidance and you are kept awake enough to respond and let us know what you are feeling. This reduces these risks and increases the efficacy significantly.
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During the heating, you may feel a reproduction of your usual back pain. This is an excellent sign that the procedure is having an effect in the correct damaged area.