Intradiscal electrothermal therapy (IDET), also called intradiscal electrothermal annuloplasty (IDEA), is a minimally invasive procedure for treating low back pain. The procedure was introduced in the 1990s to treat chronic pain originating from a damaged vertebral disc and was unresponsive to conservative therapy. Studies show that 70% of patients with chronic low back pain have improved physical function and quality of life with IDET. Previously, surgery was the only other interventional option for patients suffering from chronic pain occurring in a spinal disc.
Intradiscal electrothermal therapy (IDET) is a minimally invasive treatment for chronic low back pain related to the spine’s discs. Spinal discs act as shock absorbers between the bones (vertebrae) of the spine.
Doctors believe the pain results from nerve fibers that have grown from their normal location in the outer layers of the spinal disc into the disc’s interior. The cause is thought to be related to a breakdown (degeneration) of the disc’s tough collagen outer shell (annulus). The pain can also be from an injury that causes the soft central portion of the disc (nucleus) to move into the outer layers of the disc (herniated disc) and irritate nearby nerves.
The procedure involves the heating of a flexible catheter inserted into the damaged disc. The heat makes the tough outer shell (annulus) of the disc contract helping repair the damage and destroy painful nerves near the disc.
Conditions Treated with Intradiscal Electrothermal Therapy
IDET is a pain management option for those suffering from low back pain that originates from a damaged vertebral disc and has not responded to conservative treatments for more than six months. The procedure acts exclusively upon the tissues of the spinal disc. It does not relieve symptoms arising from other spinal structures, such as nerve roots or spinal joints.
Typically, an MRI or discography (injection of dye into the disc) is performed before IDET to clearly identify and confirm that one or more discs are the primary source of the lower back pain.
How Does Intradiscal Electrothermal Therapy Work?
The intradiscal electrothermal therapy procedure involves the threading of an electrode into a damaged disc. The exact placement of the electrode is achieved with “live” X-ray imaging (fluoroscopy). Once in place, the electrode is gradually heated.
The procedure results in a reduction of the bulge of the inner disc material. The heat causes the collagen of the disc wall to thicken (coagulate), helping seal any small tears in the damaged disc wall. The heat also destroys painful nerve endings near the disc.
IDET is an outpatient procedure and performed while the patient is awake and under local anesthesia. It does not require hospitalization. After the procedure, the patient returns home with a bandage over the needle insertion site.
What Happens Following the Intradiscal Electrothermal Therapy Procedure?
Patients should not expect immediate improvement following IDET. The recovery is gradual, and it may take several weeks for there to be any significant pain relief. For the first two weeks after the procedure, the pain may temporarily worsen in some patients because the disc requires time to heal. The healing process reaches its peak about four-to-six months following the procedure.
For the first six weeks following the procedure, the patient must also wear a back brace. The patient must limit physical activity during the recovery process and follow a graduated rehabilitation program while slowly increasing daily activities.
Doctors typically advise patients to limit sitting and standing to 30-45 minutes at a time for the two weeks immediately following the procedure. In general, patients should not return to heavy physical work during the first four months following the procedure.
Six months following the IDET procedure, patients can gradually resume all pre-procedure activities, including athletics.
Who Can Benefit from Intradiscal Electrothermal Therapy?
Studies have shown that 70% of patients with chronic low back pain can benefit from IDET. Those who are good candidates for IDET include those who experience:
Disc-related pain for at least six months.
No improvement with at least six weeks of conservative pain management, including medicine, physical therapy, or an exercise program.
Mostly low back pain, not leg pain.
Pain that is worse when seated.
In one study, 65.7% of the participants receiving IDET reported a significant degree of pain relief. After 12 months, 53% of the IDET participants had returned to work.
In another study, two years after receiving IDET, patients reported more improvement in both pain and physical functioning scores. The group’s pain scores (1-10 scale) dropped from an average of 6.6 before treatment to 3.4 one year after treatment.
Ideal candidates for IDET are patients with a single affected disc. The treatment is not recommended for people who have severe disc degeneration, spinal stenosis, or spinal instability (such as spondylolisthesis). Patients older than 55 years may have lower success rates because of generally poorer healing.
Novus Spine & Pain Center
Novus Spine & Pain Center is in Lakeland, Florida, and treats patients with chronic pain with numerous therapies, including intradiscal electrothermal therapy. By using a comprehensive approach and cutting-edge therapies, we work together with patients to restore function and regain an active lifestyle while minimizing the need for opiates.