Results of IDET in Worker's Compensation Employees
Degenerative disc disease (DDD) is a common cause of low back pain (LBP) in Worker's Compensation claims. Ten per cent of the workers aren't helped by conservative care. This group ends up needing more invasive treatment. But the treatment options are limited. For example, spinal fusion has not proven to be very helpful.
Intradiscal electrotherapy (IDET) is minimally invasive and may be an effective alternative to fusion. IDET involves the placement of a catheter (thin tube) into the disc space. Heat is delivered via a coil inserted through the catheter. The temperature of the disc is increased using thermal (heat) energy.
In this study, the results of using IDET on Workerâs Comp patients are reported. All workers had chronic disc-related LBP. Half of the patients were on narcotics for pain control. Pain and disability were measured before and after treatment. Workers on light-duty or who were off work before treatment were assessed after treatment. Return to work status and productivity were reported.
Patients were divided into three major work groups. The groups were based on degree of physical difficulty. Heavy lifters included construction workers, oil-platform workers, warehouse porters, and army Marines. Moderate laborers included assembly-line workers, maintenance crews, heavy-vehicle drivers, and security workers. The third group was labeled sedentary (desk job) workers.
The authors report significant improvement in both pain and function. Narcotic use dropped from 51 to 13 per cent. Analysis of various factors showed that age and body weight did not affect the results. Pain level and function before treatment were important factors.
Only five per cent of the workers returned to full duty. But almost half of the treatment group were able to return to light duty or full duty with some restrictions on heavy-lifting. This was a major improvement in economic productivity from before treatment. The rest of the workers (47 per cent) did not return to work.
Reports on the results of IDET are few and far between. And the results of those studies don't agree with each other. The results of this study suggest it is a safe and effective treatment for pain and disability from disc disease.
Differences in results may be based on patient selection, placement of the catheter, and heating temperature used. This was the first long-term study of Worker's Compensation employees. Younger patients with recent onset of symptoms formed a subgroup of workers. This subgroup really wanted to get back to normal and return to work.
More studies are needed to find the optimal patient and technique for this procedure. It's possible that different temperatures are needed to destroy pain receptors versus to contract collagen (tissue) fibers. For now, it appears that IDET is safe and useful for carefully selected patients. Worker's Compensation employees should not be excluded. Age, sex, and obesity do not affect the outcomes.
Pierce D. Nunley, MD, et al. Intradiscal Electrothermal Therapy (IDET) for Low Back Pain in Worker's Compensation Patients. Can It Provide a Potential Answer? Long-Term Results. In Journal of Spinal Disorders & Techniques. February 2008. Vol. 21. No. 1. Pp. 11-18.