24 Jan Intradiscal Electrothermal Annuloplasty
Intradiscal Electrothermal Annuloplasty (IDET) is a minimally invasive treatment for chronic low back pain. It is indicated for patients who have painful degenerative disc disease or contained disc herniation. IDET treatment can be very effective in providing pain relief and is a minimally invasive alternative to major spinal surgery for disc removal/spinal fusion or disc replacement.
IDET It is a relatively short outpatient procedure (up to 1 hour) and involves inserting a catheter into the disc and introducing heat to the sensory nerve endings carrying pain. Heat-induced contraction of collagen tissue within the disc wall that may seal up painful tears and stimulate new collagen formation, but that is not fully understood.
An IDET procedure is preceded by a discogram test in which the abnormal lumbar disc or discs are identified and injected with a contrast agent. A positive discogram is the one that reproduces the patient’s pain.
After the discogram, the patient is sedated and a flexible catheter is inserted into the target disc under x-ray guidance and navigated into the proper position. The catheter is placed along the posterior disc wall and then heat is applied (90 degrees Celsius for 15 to 16 minutes). Following that, The catheter is then removed and the disc is injected with a small amount of antibiotic and anesthetic medication is applied.
Post-procedural care involves placing a low back brace and patients are advised to minimize activities that stress the low back. Pain medications may be given to provide comfort in the early recovery period. After two months of low back protection, four weeks of physical therapy is recommended that focuses on strengthening the of the lower back musculature.
The outcomes have been encouraging. Nearly half 50% of patients undergoing IDET report good pain relief.
Patients with less severe disc degeneration are thought to be the best candidates for the procedure and have the highest likelihood of a favorable response.
There are a few complications associated with IDET and include disc space infection, nerve root injury, post-treatment disc degeneration or herniation, and post-treatment increase in back pain, which are all considered to be quite rare.
Careful patient selection and preparation is important. It is important that the patient has consulted a spine specialist for proper assessment of his/her condition.
The initial workup also includes getting a diagnostic and a confirmatory test, such as plain x-rays and an MRI scan, respectively. As IDET is best suited for patients who have tried and failed conservative pain treatments, it’s important to establish that well. These include oral medications, physical therapy, epidural steroids, etc. Before opting for IDET, patients need to be fully informed about what is going to happen and why it’s being suggested and counseled on the risks and benefits of the procedure. That way, they are in the best position to decide whether to choose this procedure over other options.