At Advanced Pain Consultants, we provide state-of-the-art pain treatments. One of the innovative techniques we use to treat persistent low back pain is called intradiscal electrothermal therapy (IDET). This is a minimally invasive procedure that uses controlled levels of thermal energy (heat) to treat damaged spinal discs (the cushions between vertebrae).
The heat performs three tasks: It destroys the pain receptors in the disc, cauterizes the new nerves and blood vessels that have grown into the degenerated discs, and repairs the structure of the disc by “melting” any tears or cracks—all of which helps to reduce pain.
Dr. Pasi may advise a patient to undergo IDET following a discogram (when the results indicate there’s a tear or other damage within the disc) and before performing a disceptomy (surgery to remove a damaged intervertebral disc). Sometimes a successful IDET treatment provides a patient with enough pain relief that major spinal surgery for disc removal, spinal fusion or disc replacement is no longer necessary.
Candidates for IDET are patients with chronic lumbar (lower back) pain resulting from internal disc tears, small disc herniations, or mild disc degeneration (limited to one or two vertebral segments). Usually the patient has been experiencing lower back pain for at least 3 to 6 months, and has used more conservative, non-surgical methods of treatment (such as medication, dietary modifications, stretching, exercise and physical therapy), which have been ineffective at relieving the pain or healing the disc.
IDET is not recommended for people who have severe or multiple disc degeneration, fully-herniated discs, nerve compression, spinal stenosis (narrowing of the spinal column), spinal instability (such as spondylolisthesis), or any other medical condition, including pregnancy, that could increase the risk of surgery or make follow-up care difficult.
The IDET treatment is an outpatient procedure which can be performed in our medical office or at a local surgery center. The entire procedure is done under a local anesthetic (numbing agent) and a sedative (administered by IV to make the patient more comfortable). In most cases, an IDET treatment takes less than an hour to complete.
Dr. Pasi begins the procedure by injecting a local anesthetic into the treatment area. Once the anesthesia has taken effect, a hollow needle (cannula) is placed in the affected lumbar disc using x-ray guidance (fluoroscopy). An electrothermal catheter (heating wire) is passed through the needle and into the disc. Once the catheter is in the appropriate position, the temperature of the heating section of the catheter will be gradually increased to about 194 degrees Fahrenheit (90°C), which will heat-up the disc wall temperature. Each disc being treated will be heated for approximately 17 to 20 minutes. This will cause the disc’s fibers to contract, close any tears, and burn the tiny nerve endings in the disc to make them less sensitive to pain.
Once the therapy is completed, the electrothermal catheter and needle will be removed, and then a bandage will be placed over the needle insertion site. After a short observation period in the recovery room, the patient is then released and sent home.
Studies show that IDET produces effective pain relief in 75 to 80 percent of patients who undergo this procedure. Relief is not immediate, though. For most patients, improvement is seen around 2 to 3 weeks after the procedure. Some patients do report relief in as little as three days, while others do not start experiencing improvement in their symptoms until 12 to 16 weeks after their procedure. Physical therapy, stretching, and rehabilitation exercises are a necessary part of recovery; this should be started 8 to 12 weeks after IDET.
If you suffer from discogenic back pain (pain that originates from a damaged vertebral discs) which has been unresponsive to traditional pain management therapies, intradiscal electrothermal therapy may be an option. To learn more about this procedure or to schedule an evaluation with Dr. Pasi, please call Advanced Pain Consultants at (919) 510-7901 to book your appointment.