IntraDiscal ElectroThermal (IDET) Therapy

The IDET procedure offers a non-surgical option to treat back pain. A catheter that uses heat modifies the protein wall of the disc and reduces the amount of disc material that causes nerve irritation.

This is a minimally invasive procedure performed in an outpatient surgical center. The procedure involves a special wire (the catheter) which is guided into your disc through a spinal needle and is heated for about 15-20 minutes. One or multiple disc levels can be treated with IDET. The catheter and needle are removed, and you will be discharged home with specific instructions.

Pre-Operative Preparation
One week before the procedure you should do the following:
• Stop all NSAID's, aspirin and aspirin containing compounds.
• Do NOT discontinue heart, blood pressure or diabetes medications, or other medications prescribed by your physician.

Be sure to tell your physician if:
• You are taking blood thinners or have a history of a bleeding disorder
• You are allergic to iodine (for example, shellfish or IVP dye)
• You have fevers, or signs of infection

You should not eat the day of your procedure. Small amounts of clear liquids are permitted. Arrange to have someone drive you to and from the surgical center.

The Procedure
An I.V. will be placed in your arm and you will be given a light sedative. After you are in position on the table, x-ray equipment will identify the disc level(s). Your lower back skin and muscle tissue will then be numbed with local anesthetic.
Your physician will place a needle into your disc under x-ray guidance. You may experience pressure during this part of the procedure. Once the needle is in the proper position, your physician may inject dye into the disc for diagnostic purposes.
The electrothermal catheter is then inserted through the needle. Patients typically do not feel any discomfort during this step. However, some patients feel pressure in their back when the catheter moves through the disc.

IDET Catheter in a lumbar disc
When the catheter position is confirmed by x-ray, the heating element is activated. The heat is slowly increased and will last for 15 to 18 minutes. As the heat increases into the treatment range, you might experience your typical disc-related symptoms. Your physician will monitor your responses during the procedure to ensure that any discomfort you feel is well controlled.
At the end of the procedure, a bandage will be placed on your back, and you will rest in a recovery area until you are ready to go home.

Post-operative Management
In the first three days after your procedure (the immediate postoperative period), you may experience a moderate increase in your normal back pain. Rest, ice, pain medication and anti-inflammatories will minimize possible discomfort during this time. Any unusual or new symptoms (i.e., fever, chills, rash, increased numbness or weakness) should be reported to your physician. Do not expect your usual pre-procedure symptoms to immediately disappear.

You should not exert yourself during this time, even if you experience a marked reduction in your usual pre-procedure pain, because exertion may negatively affect the overall outcome. No housework, lifting or bending should be done. Short walks (15 to 20 minutes) are okay, but generally the first few days should be spent resting. You should discuss with your physician your plan to return to work. If your work is sedentary, you can typically return 1 to 5 days after the procedure. A follow-up appointment will be made with your physician for additional treatment recommendations.

For the few weeks following the procedure as your disc(s) heal, you should begin to feel a reduction in pain. However, pain reduction may occur over 3 months. During the first month, you must treat your back carefully. Restrict bending twisting or heavy lifting. You will be instructed to wear a soft lumbar brace for several months following the procedure. No sports will be allowed.

You may resume back exercises under your physician's guidance. Anti-inflammatory medications and/or pain medication may be prescribed if needed to control discomfort associated with your normal back pain. Icing 1-2 times per day (10-15 minutes) is advisable to reduce any low back discomfort.

Rehabilitation Exercises and Therapy
Your physician will guide you regarding rehabilitation exercises after your procedure. If you have been performing strenuous rehabilitation exercises before the procedure, you will not immediately return to that level of exercise, but to a more moderate level that will be gradually increased as you improve.
Your physician will help you advance your exercise program to improve your strength and flexibility. Your physician may allow you to resume sporting activity 3-4 months after the procedure and may allow you to resume traveling for work or pleasure during this time as well.