Intradiscal Electrothermal Therapy (IDET)

Intradiscal electrothermal therapy (IDET) is a minimally invasive procedure for the treatment of low back pain resulting from problems with the spinal disc.

Patients with low back pain caused by problems with the spinal disc who don’t find improvements using other conservative treatment options may find improvements with this procedure.

IDET involves the use of a flexible catheter which is inserted into the spinal disc under fluoroscopic guidance. The catheter comprises of a thermal coil that heat up the outer part of the disc, resulting in the contraction of collagen fibers and destruction of the pain receptors.

Studies have shown that 70% of patients with chronic low back pain have experienced significant improvements from IDET. It has helped to improve the physical function and quality of life of most patients.

Who is an ideal candidate for intradiscal electrothermal therapy?

Intradiscal Electrothermal Therapy (IDET)

Patients who have had low back pain that does not radiate to the limbs for more than six months and haven’t experienced improvements from other conservative treatments may be considered for IDET.

Patients with a single affected spinal disc are considered ideal candidates for IDET.

Major spinal disc damage like disc collapse may not respond to IDET.

The status of the spinal disc can be assessed by imaging scans such as X-ray and magnetic resonance imaging (MRI).

Older patients of more than 55 years of age may have lower success rates from IDET because of poorer healing.

Patients that smoke may have lower success rates because smoking may affect collagen tissue and delay recovery.

Preparing for intradiscal electrothermal therapy procedure

Before undergoing IDET, you will first have to undergo some exams and tests.

An exam will be conducted to make sure you are healthy enough to undergo the procedure. Tests will also be performed to provide useful information about your disk to your doctor.

The tests that will be conducted include:

  • Discogram 

    A discogram is an imaging test done to pinpoint the exact disk causing the pain. The tests involve injecting a contrast dye into the disk which allows your doctor to see the disk more clearly on X-ray.

  • Imaging tests 

    Imaging tests such as an MRI or a CT will also be conducted to help your doctor know more about the extent of damage to your disk.

Before the procedure;

  • Inform your doctor about all the medications, supplements, and herbs that you are currently taking. Your doctor will instruct you on the medications that you need to stop taking.
  • You will have to stop eating and drinking 8 hours before the procedure.
  • You will need to arrange for someone that will drive you home after the procedure because you won’t be able to drive.

How intradiscal electrothermal therapy is performed

Intradiscal Electrothermal Therapy (IDET)

IDET is usually performed on an outpatient basis. This means you can go back home after the procedure.

You may be administered local anesthesia and mild sedation to reduce discomfort and pain during the procedure. You will be awake and alert throughout the procedure so that you can provide important feedback to your doctor.

You will be made to lie down on your stomach. Your physician will advance a needle into the affected disc using X-ray guidance. A catheter will be passed through the needle and into the disc. When the catheter is in the appropriate position, the temperature of the heating section of the catheter will be increased gradually to increase the temperature of the disc wall.

The temperature will be increased from 98.6 to 167 °F. After the temperature has remained at 167 °F for one minute and you do not complain of excessive pain or discomfort, your physician will increase the temperature by 1°F every 30 seconds until it reaches between 176° to 194 °F.

Your physician will closely monitor your condition and comfort level. You will most likely start to feel your usual lower back pain. When you start feeling the pain, it is an indication that the heat is being applied to the appropriate areas.

The heat-sensitive hydrogen bonds of the collagen fibers will break causing collagen contraction.

The heat contracts and thickens the collagen of the disc wall. The heat also raises the temperature of the nerve endings. The heat may also result in the contraction or closure of the disc wall fissures. It may also result in the reduction in the bulge of the inner disk material, and desensitization of the pain sensors within the disc.

Once the procedure is completed, the catheter and needle will be removed. A small bandage will be used to cover the site where the needle was inserted.

After the procedure

You may experience discomfort generated when the disc was heated for several days. Your doctor may prescribe medication to help with the discomfort.

The disk healing process may take up to 12 to 16 weeks. It may take 8-12 weeks before you start to experience significant pain relief.

Your doctor will provide you with activity and physical rehabilitation guidelines to aid your recovery.

You should only do minimal sitting or standing during the first few days.

You may need to wear a back brace during the first six weeks.

After six months, you can gradually resume your normal activities.

You will begin to experience pain relief during your recovery time. You may also begin to experience increase in your functional abilities.

You may continue to experience improvements up to six months following the procedure.

The healing process reaches its peak after four months of the procedure.

Activities in the first week

Intradiscal Electrothermal Therapy (IDET)

What you can do in the first week following the procedure are as follows:

  • You can take minimal walks
  • You should always wear a brace during all activities
  • You can sit for only 35-45 minutes at a time
  • Avoid lifting, twisting, bending, or driving
  • You shouldn’t go to work or engage in any strenuous activities
  • Avoid any physical therapy

Activities in weeks 2-6

What you can do in the 2-6 weeks following the procedure are as follows:

  • You should always wear a brace during all activities
  • Increase your sitting time as much as you can
  • Avoid lifting objects that are more than 10 lbs.
  • You can drive during this time
  • Avoid twisting or bending
  • You may return to light or sedentary work
  • Avoid any physical therapy

Activities in weeks 6-12

What you can do in the 6-12 weeks following the procedure are as follows:

  • Do not life objects that are more than 25 lb
  • Avoid twisting or bending
  • You may start physical therapy

Activities beyond week 12

Intradiscal Electrothermal Therapy (IDET)

What you can do after week 12 following the procedure are as follows:

  • You can lift objects that are not above 50 lb
  • You may return to work and normal activities
  • You can start physical therapy and home exercise program

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