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IDETIntraDiscal Electrothermal Therapy, commonly referred to as the "IDET Procedure" is a recently developed technique for the treatment of low (lumbar) back pain coming from a spinal (vertebral) disc. Vertebral discs are located between each vertebra of the spine and act as a shock absorber. They are composed of two parts: a though outer shell called the "annulus" and a soft jelly-like inner core called the "nucleus." Two major conditions affect the disc; one is disc herniation and the other is degenerative disc disease. Disc herniation is usually the result of some form of injury to the disc causing the disc to budge or rupture. This ruptured disc may press up against a spinal nerve causing pain and numbness, tingling or weakness in your legs. Degenerative disc disease is normally the result of aging. At birth, about eighty percent of disc's nucleus is water. Due to years of wear-and-tear from lifting and other activities, the nucleus has a tendency to lose this water, causing the annulus to bulge, weaken, and sometimes tear. The body will attempt to heal this tear; however, since the disc does not have adequate blood supply, the healing process fails, resulting in pain. In addition, chemicals from the nucleus probably leak through the torn annulus, causing painful inflammation to the nerve roots. During the procedure, the doctor will use a temperature controlled heat source inside a thin catheter to deliver high heat to the torn annulus. The heat will cauterize the small nerve fibers and blood vessels, and shrink the material that makes up the annulus. The shrinkage improves disc function and the cauterization of the nerve fibers relieves pain. IDET is performed only on patients who have failed conservative therapy such as epidural steroid injections, physical therapy, and medications. Procedure OverviewIDET is an outpatient procedure performed in the Operating Room under strict sterile conditions. When brought to the Operating Room, you will be connected to monitoring equipment (EKG monitor, blood pressure cuff, and a blood-oxygen monitoring device). The doctor or nurse will start an intravenous line and give some medicine to help you relax. The procedure is performed with you lying on your stomach. The doctor will cleanse your lower back with antiseptic solution and inject some numbing medicine deep into your skin and tissue. You may feel a burning sensation for a few seconds. After the area is numb, and, with the assistance of a special X-ray machine called a fluoroscope, a hallow introducer needle is inserted into the disc. An electrothermal catheter (heating wire) is then passed through the needle into the disc, wrapping around it. The catheter tip is slowly heated up to 90 degrees Celsius (140 degrees Fahrenheit) for 14 to 17 minutes. During the heating process, you will most probably feel a reproduction of your usual back pain. This is a strong indication that the heat is being applied to the appropriate areas. Once the therapy is completed, the catheter is removed and the site covered with a band-aid. We ask that you remain at the Clinic until the doctor feels you are ready to leave. |
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Procedure DetailsWill you be asleep for the procedure? Since you need to communicate with the doctor and tell him the type of pain you are experiencing, you will not be put to sleep. However, you will receive enough medication to keep you comfortable. How long will the procedure take? Normally, IDET takes from 60 to 90 minutes for each disc. Before the procedureDo not eat or drink anything after midnight the day before the procedure. If you are on medications, you may take them with sips of water. If you are a diabetic, discuss your medication with your doctor. You may need to stop taking certain medications several days before the procedure. Please remind the doctor of all prescription and over-the-counter medications you take, including herbal and vitamin supplements. The doctor will tell you if and when you need to discontinue the medications. It is very important to tell the doctor if you have asthma, had an allergic reaction (i.e. hives, itchiness, difficulty breathing, any treatment which required hospitalization) to the injected dye for a previous radiology exam (CT scan, angiogram, etc) or if you have had an allergic reaction to shellfish (shrimp, scallops, lobster, crab). The doctor may prescribe some medications for you to take before having the procedure. Tell the doctor if you develop a cold, fever, or flu symptoms before your scheduled appointment. After the procedureDrink plenty of clear liquids after the procedure to help remove the dye from the kidneys. Please have an adult drive you home or accompany you in a taxi or other public transportation. You will probably experience mildly increased pain after the procedure, lasting a few days or weeks. Pain medication can be used. It is most important to limit stress on the heated disc to allow full healing. Very specific physical restrictions apply: Rest for 1 to 3 days after the procedure. Until you begin your physical therapy program, the only exercise allowed is light walking. Do not bend or twist at the waist. Proper body mechanics will be taught. For the first two weeks, vertical sitting is allowed for 30 to 45 minutes a day, then increased as tolerated. A brace (corset) that can be worn under the clothes should be used for about six weeks. The purpose of the brace is to limit your activity. You may remove the brace for showers or sleeping. The doctor will give you instructions for returning to work. In general, if your work is sedentary you can probably return in 3 to 5 days. You may also do light housework after one week. Under no circumstances is heavy work or aggressive physical activity allowed until at least six months after the procedure. You may begin driving 3 to 5 days after the procedure, but only for limited amounts of time. When you start physical therapy, it is very important that you continue with the program as prescribed. Procedure RisksAlthough very few complications have been reported, the risks involve nerve injury, infection, and worsening of the pain. If you experience severe back pain or signs of infection in the area of the injection, you should call the doctor right away. |
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