Intradiscal electrothermic therapy (IDET) for low back pain

Surgery Overview

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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 . 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

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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

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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

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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

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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

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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.

References

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Citations

1. Lutz C, et al. (2003). Treatment of chronic lumbar diskogenic pain with intradiskal electrothermal therapy: A prospective outcome study. Archives of Physical Medicine and Rehabilitation, 84(1): 23–28.

2. Saal JA, Saal JS (2002). Intradiscal electrothermal treatment for chronic discogenic low back pain: Prospective outcome study with a minimum 2-year follow-up. Spine, 27(9): 966–974.

3. Davis TT, et al. (2003). Lumbar intervertebral thermal therapies. Orthopedic Clinics of North America, 43(2003): 255–262.

4. Gibson JNA, Waddell G (2005). Surgery for degenerative lumbar spondylosis: Updated Cochrane review. Spine, 30(20): 2312–2320.

5. Freeman BJC, et al. (2005). A randomized, double-blind, controlled trial: Intradiscal electrothermal therapy versus placebo for the treatment of chronic discogenic low back pain. Spine, 20(21): 2369–2377.

Credits

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Author	Shannon Erstad, MBA/MPH
Author	Lila Havens
Editor	Kathleen M. Ariss, MS
Editor	Katy E. Magee, MA
Associate Editor	Michele Cronen
Associate Editor	Tracy Landauer
Primary Medical Reviewer	William M. Green, MD - Emergency Medicine
Primary Medical Reviewer	Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer	Kathie Hummel-Berry, PT, PhD - Physical Therapy
Specialist Medical Reviewer	Robert B. Keller, MD - Orthopedics
Last Updated	February 15, 2006