Careful Patient Selection Yields Good Results With IDET
Intradiscal electrothermal therapy is a minimally invasive treatment for patients with disc-related pain. On the continuum of care, it falls someplace between a conservative (nonoperative) approach and the more invasive spinal surgery.
Doctors are finding that IDET is most successful when used with certain patients. Carefully screening patients before accepting them for this treatment yields the best results.
In this study, diagnostic tests were done first to confirm the disc as the source of pain. MRI, discography, and CT scans were used to make the diagnosis. Each patient had low back pain that did not respond well to at least six months of conservative care.
Heat was applied to the disc through an intradiscal catheter (thin tube inserted into the disc). Heat destroys collagen fibrils and cauterizes granular tissue that forms as a result of an inflammatory response. Nerve fibers are also destroyed but without destabilizing the spine.
Patients were tested before and after treatment. Measures included pain intensity, function, and health-related quality of life. Follow-up was at least one year. Most patients were retested at 12, 18, and 24 months after IDET.
Success was defined as a two-point (or more) improvement in pain (measured on a scale from zero to 10) and at least a 10-point improvement on the SF-36 test. The SF-36 test provides a measure of physical and mental health.
Results were reported as successful for 75 per cent of the patients. Improvement in sitting, standing, and walking was very noticeable. Quality of life in the areas of emotional and mental health was also greatly improved. There were no cases of infection, nerve damage, or other post-IDET complications.
The authors conclude that IDET provides a middle step between conservative care and surgery for many patients. Clear radiographic evidence of internal disc disruption is needed before using this treatment approach. IDET has the added benefit of preserving the disc and spinal motion. If unsuccessful, then surgery can be considered at a later date.
Philip Maurer, MD, et al. Intradiscal Electrothermal Therapy (IDET) Provides Effective Symptom Relief in Patients with Discogenic Low Back Pain. In Journal of Spinal Disorders & Techniques. February 2008. Vol. 21. No. 1. Pp. 55-62.