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Lumbar Intradiscal Electrothermal Therapy (IDET)

What does “Lumbar Intradiscal Electrothermal Therapy” mean?

Here is the meaning of each word:

  1. Lumbar: area of the spine located in the low-back
  2. Intradiscal: inside the disc of the spine
  3. Electrothermal: generating heat with electricity
  4. Therapy: to help a disease process

Altogether Lumbar Intradiscal Electrothermal Therapy (IDET) means treating a diseased disc of the low back with heat therapy.

What is Lumbar Intradiscal Electrothermal Therapy (IDET)?

IDET is a procedure which delivers targeted heat energy to the outer ring (annulus fibrosus) of a diseased disc.

A needle is placed into the diseased disc, followed by an electrical wire (IDET catheter) which is inserted through the needle and advanced into the disc. The wire is attached to a Radiofrequency Generator which generates heat energy at the tip of the wire. The wire delivers the heat to the outer ring of the disc (annulus fibrosus).

IDET procedures are done primarily for degeneration of the outer ring of the disc. The outer ring is responsible for supporting the inner core (nucleus pulposus) of the disc. This is a critical role, since a failure of the outer ring can cause a disc to herniate. If the outer ring becomes brittle and fails, the softer material of the disc’s core (nucleus puplosus) will herniate through the outer ring.

The IDET procedure is done in hopes of “healing” or restoring the function of the outer ring of the disc.

How does the Disc’s outer ring (annulus fibrosus) degenerate?

The disc’s outer ring (annulus fibrosus) consists primarily of collagen fibers. These are tough fibers similar to ligaments in the body which connect bone to bone. The outer ring is commonly degenerated by repeated lifting, bending and twisting injuries. The ring becomes inflamed which starts a process of progressive deterioration. Eventually, cracks or tears form in the outer ring. These cracks can lead to chronic pain and inflammation which can be felt as mid-back and chest pain.

This process can start as early as our childhood or teenage years and will continue throughout our adulthood.

How does a Spine Specialist know if a Disc’s outer ring (annulus fibrosus) is degenerated?

Spine specialists use information from MRI scans and Discograms to make the diagnosis if a degenerated annulus fibrosus.

The MRI scan can show details of the annulus such as tears in it’s fibers.

During a discogram, dye is injected into the disc. During the injection, two things are evaluated:

1. Pain perceived by the patient.

2. The appearance of the dye inside the disc.

If the annulus is degenerated, the dye will show a pattern of dye flowing from the nucleus into the annulus. Sometimes, the dye will leak through the annulus towards the spinal nerves.

The information gained from the MRI and Discogram tells the spine specialist if a patient is a candidate for an IDET procedure.

How does the Radiofrequency Heat Energy heal a disc?

The IDET procedure uses specific Radiofrequency energy to generatetargeted heat energy. This heat energy is thought to strengthen the collagen fibers in the annulus. As the heat is delivered to the collagen fibers, a chemical process is initiated which can eventually lead to a thickening and tightening of the collagen fibers, giving the disc a stronger annulus. This process is also thought to close any tears in the annulus.

How is a Lumbar IDET procedure done?

Here are some of the steps of how this procedure is performed:

  1. An intravenous catheter (IV) is started. Relaxing medication (sedation) and antibiotics are often given.
  2. This procedure is done in an Operating Room or Procedure Room.
  3. The patient is placed on their stomach (prone).
  4. The low-back is carefully cleaned with an anti-septic solution.
  5. Sterile sheets (drapes) are placed around the area.
  6. Local anesthetic is injected under the skin.
  7. A specialized needle (IDET needle) is placed through the skin.
  8. Using an X-Ray machine, the needle is advanced into the disc.
  9. An IDET catheter (electrical wire) is placed into the disc and advanced around the area where the nucleus and annulus meet. Care is taken that the active tip of the catheter is in contact with the diseased part of the annulus.
  10. The IDET catheter is connected to a Radiofrequency Generator.
  11. The generator is programed to deliver the heat energy at a certain temperature for a certain length of time. This is called the “IDET profile”. Various profiles exist for different types of disc issues.
  12. After the heating profile has finished, the catheter is removed.
  13. Sometimes, antibiotic is injected in the disc at this point.
  14. The needle is removed.
  15. A sterile band-aid or bandage (dressing) is placed.
  16. The patient is turned on the back and brought to the Recovery Area.
     

How long does it take to do an IDET procedure?

An IDET procedure can take 30-45 minutes to be completed for one spinal disc level.

 

What is the recovery like from an IDET procedure?

Here are some of the steps of the recovery from this procedure:

  1. This procedure is done as an Outpatient Procedure.
  2. The patient is usually given specific limitations on their activities. This may involve limited bending, lifting, twisting, running, etc.
  3. The patient is often reevaluated by the doctor within several weeks after the procedure.

What kind of benefit can patients gain from an IDET procedure?

The benefit from this procedure may not be immediate. Often, the process of healing of the annulus may take weeks to months to complete.

Depending on the original symptoms a patient has, this procedure can potentially relieve low-back and leg pain for the longer term.