IDET (Intradiscal Electrothermal Annuloplasty)

IDET or Intradiscal Electrothermal Annuloplasty is a relatively new procedure to treat disc-related back pain. It is a new alternative to other surgical procedures for patients who suffer from back pain caused by certain types of disc problems. It is an outpatient non-operative procedure which is minimally invasive — there is no incision and can be done using local anesthetic and sedation.

The procedure is made possible by the development of electrothermal catheters that allow for more careful and accurate temperature control. The procedure works by cauterizing the nerve endings within the disc wall to help block the pain signals.

IDET is a minimally invasive outpatient surgical procedure developed over the last few years to treat patients with chronic low back pain that is caused by tears or small herniations of their lumbar discs.

The Day of the IDET Procedure:

The IDET treatment is an outpatient procedure done in Rush University Medical Center or Rush Oak Park Hospital. On the day of the procedure, nothing but sips of water should be taken by mouth for eight (8) hours prior to your appointment. The patient should continue to use their usual medications on the day of the procedure. Only anti-inflammatories or aspirin type medications need to be discontinued 3-4 days before the treatment.

When the patient arrives, they will be dressed in a loose gown and shorts we provide, given a physical exam, and then taken to the surgical suite.

A small amount of sedative is given by IV to help make the patient comfortable. Usually placing the catheter into the disc is not complicated. Once the catheter is well positioned, each disc treated will be slowly and progressively heated for about 17 minutes.

After the treatment, the patient is taken to the recovery room for about I hour.
If needed, pain medication will be given by vein or by mouth.

The IDET process takes about an hour to complete and is done as follows:

• The procedure is performed with a local anesthetic and mild intravenous(IV) sedation.
• A hollow introducer needle is inserted into the painful lumbar disc space using a portable x-ray machine for proper placement.
• An electrothermal catheter (heating wire) is then passed through the needle and positioned along the back inner wall of the disc (the annulus), the site believed to be responsible for the chronic pain. The catheter tip is then slowly heated up to 90 degrees Celsius for 15-17 minutes.
• The heat contracts and thickens the collagen fibers making up the disc wall, thereby promoting closure of the tears and cracks. Tiny nerve endings within these tears are cauterized (burned), making them less sensitive.
• The catheter is removed along with the needle and, after a short period of observation, the patient goes home.
• A lumbar support is worn for 6 to 8 weeks, followed by an appropriate course of physical therapy. Lifting and bending precautions are necessary during this time to allow for adequate healing of the disc.

Recovery

• For most people there is a period of mildly increased pain after the procedure lasting a few days or weeks.

• Pain medication can be used.

• Physical therapy may be started when post-procedure pain is less marked but usually begins 6-12 weeks following the treatment.

• Maximal healing following the procedure may take as long as 4 to 6 months.

• It is most important to limit stress on the heated disc to allow full healing.

• Very specific physical restrictions are advised. They involve very limited bending and twisting at the waist, minimal lifting, and only short periods of sitting upright.

• Other than light walking, no specific exercise is allowed until physical therapy is initiated. Activity is then progressed under therapist and physician supervision on an individual basis.

• People who have sedentary jobs where they can observe activity precautions may return to work in less than a week. Under no circumstances is heavy work or aggressive physical activity allowed until at least six months after the treatment.