The evolution of IDET
Low back pain occurs in about 90% of all people at some time in their lives! Incapacitating cases of back and leg pain may lead to stress and financial hardship. Despite the "miracles" of modern medicine, simple and effective solutions to this very common problem have been elusive.
One problem in understanding "low back pain" is that it describes a symptom not a specific disease. We are beginning to realize that low back pain can be the result of many different physical problems. Our challenge is to determine the source(s) of spine pain and to develop specific effective treatments. This process can be complicated and is not always successful.
It is becoming clear that chronic low back and leg pain is often the result of damage to discs. This is termed "discogenic" pain and can occur without the herniation or rupture that many people identify with disc problems. Discs are complex rubber-like structures between the bones of the spine. They are particularly prone to "wear and tear" damage or may be injured in an accident. Both types of disc injury can result in tears of the outer wall of the disc. These tears may be painful. We do not yet understand why some people develop painful tears and others do not. It appears that damaged discs may become painful due to the irritation of small nerves in the damaged outer wall of the disc or due to irritation and pressure on nerves that grow into the disc with scar tissue. A solution to this pain would be to strengthen the torn, weakened disc wall and to deaden the painful nerves.
What is IDET?
IDET is a fairly new, minimally invasive procedure used to help treat discogenic low back pain. Heat is delivered by means of a catheter to within the affected disc, killing nerve fibers and strengthening the tissue in order to seal painful fissures. The IDET procedure is performed on an outpatient basis and takes about an hour to complete, with an additional hour of recovery time. Optimal results are usually seen at six months post-procedure. It is most often utilized in cases of chronic (at least six months duration) disc-related low back pain which has not been helped by aggressive nonsurgical treatment.
IDET is not recommended for those with severe disc degeneration, nerve compression, spinal stenosis, and/or spinal instability (such as spondylolysis).
How is IDET determined to be the right treatment?
The history of a patient's pain, their physical exam, x-rays and MRI scans can suggest the presence of painful damaged discs. Confirmation is provided by a diagnostic disc injection test - also called a discogram. This involves the placement of a thin needle into the disc using an X-Ray machine followed by the injection of contrast dye. The contrast fills disc tears if present. Pressure inside the disc may trigger discomfort if the disc is sensitive. Undamaged discs are not usually painful.
What should I expect the day of the procedure?
The IDET treatment is an outpatient procedure. On the day of the procedure, nothing but sips of water should be taken by mouth for 4 hours prior to your appointment. You should continue to use your usual medications on the day of your procedure. Only anti-inflammatory or aspirin type medications need to be discontinued 3-4 days before your treatment. When you arrive you will be dressed in a loose gown. After a brief discussion and physical exam, you will be taken to the procedure room. A small amount of sedative is given by IV to make you comfortable. Usually placing the catheter into the disc is not complicated. Once the catheter is well positioned, each disc treated is slowly and progressively heated for about 17 minutes. After the treatment, you are taken to the recovery room for about 1 hour. If needed, pain medication will be given by vein or by mouth.
What should I expect during recovery?
For most people there is a period of mildly increased pain after the procedure lasting a few days or weeks. Pain medication can be used. Physical therapy may be started when post-procedure pain is less marked but usually begins 6-12 weeks following the treatment. Maximal healing following the procedure may take as long as 4 to 6 months. It is most important to limit stress on the heated disc to allow full healing. Very specific physical restrictions are advised. They involve very limited bending and twisting at the waist, minimal lifting, and only short periods of sitting upright. Other than light walking, no specific exercise is allowed until physical therapy is initiated. Activity is then progressed under therapist and physician supervision on an individual basis.
Are there any risks or side effects associated with IDET?
There are few risks associated with the IDET. Because the procedure is performed under strict sterile conditions, the risk of infection is minimal. In addition, patients are given antibiotics for the procedure. Nerve root injury is avoided with careful needle placement under x-ray, and monitoring the patient for discomfort. The risks of infection, nerve injury and those associated with sedation are much lower than open surgical procedures on the spine. Patients usually have some injection site tenderness that lasts up to one week and are given narcotic medications over this time.
