IDET (“EYE-det”) stands for Intradiscal Electrothermal Therapy—a safe and effective procedure that has been available since 1998. The IDET procedure uses precisely placed and controlled heat to treat chronic discogenic lower back pain—that is, pain caused by injury to one or more of the cushion-like disks that separate the bones in your spine.
- The IDET procedure has been proven safe and effective in multiple clinical studies.
- The IDET procedure requires less recovery time than conventional surgery.
- The IDET procedure should not affect your eligibility for conventional surgery at a later date.
- The IDET procedure costs less than back surgery.
IDET is performed as a same day procedure and usually takes about 30-60 minutes for each disc treated. Afterward, you spend about an hour in the recovery room under observation. Then you are released to go home. Major steps in the procedure are outlined below:
- You are lightly sedated for relaxation.
- With the aid of real-time x-ray (C-ARM fluoroscopy), the doctor inserts a hollow needle into the damaged disc.
- A small wire-like probe is then inserted into the needle and pushed very carefully until the heatable tip is near the area of disc injury. It is this heat on the disc that provides the long-term therapeutic effects of the IDET procedure.
- After the probe is removed, a small amount of antibiotic may be delivered to the disc through the hollow needle to guard against infection.
- The needle is removed, a sterile bandage is placed over the area of the needle stick, and you are taken to a recovery room.
- After about an hour of being monitored in the recovery room, you can usually be driven home.
Safe insertion and precise positioning of the SPINECATH catheter is made possible with C-ARM fluoroscopy, a sort of real-time x-ray motion picture that allows the physician to see what’s happening as it happens.
When the tip of the catheter is placed in the injured disc, a controlled dose of heat is delivered. The heat contracts and thickens collagen fibers in the disc wall, potentially closing the cracks and tears and cauterizing the tiny nerve endings that can cause pain.
IDET is a safe and effective procedure for chronic discogenic lower back pain, but it’s not for everyone
If your lower back pain is disc-related, the IDET procedure may offer the following benefits:
- The IDET procedure may close small tears and fissures associated with disc pain and help restore disc functioning.
- The IDET procedure may provide a significant reduction in pain—enough to restore mobility and help you get back to work.
- The IDET procedure may eliminate lower back pain that no combination of rest, physical therapy, pain medication, careful exercise, and other nonoperative measures could successfully control.
Indications for IDET
- You have chronic lower back pain. This means the pain has been with you continually for at least 3 months (some doctors say 6 months).
- You have tried aggressive, nonoperative therapy (which may include rest, pain medication, physical therapy, careful exercise, and perhaps alternative treatments), but after 6 weeks, the results were not satisfactory and the pain is still there.
- Your doctor has ruled out certain “red flag” causes of lower back pain, such as cancer or infection.
- Your doctor has performed the necessary diagnostic work-up, including provocation discography (the injection of special X-ray contrast into the suspect disc to provoke discogenic pain).
- The injured disc maintains its basic shape and structural integrity, and no more than 2 discs are thought to be involved.
- You are willing and able to follow the doctor’s instructions to prepare for the IDET procedure and to help ensure a good outcome in the months that follow.
Who should not receive IDET
The IDET procedure isn’t for everyone. The following conditions might exclude a patient from receiving the IDET procedure.
- Disc height less than 50% of predicted original height
- Prior surgery on affected discs
- Successful or failed spinal fusion surgery
- Spinal stenosis
- This is a narrowing of the holes in the vertebrae through which nerves and the spinal cord pass
- Large or extruded disc herniation
- A herniated disc bulges out between its two companion vertebrae. An extruded herniation has bulged so badly that it has torn and is leaking disc contents. Herniated discs are sometimes informally referred to as “slipped discs”
- Physical deformities of the spine, including scoliosis, kyphosis, and spondylolisthesis.
- In addition, cigarette smoking and obesity are associated with poor results in clinical studies of the IDET procedure. If you are considering the IDET procedure and are a smoker and/or overweight, discuss these issues with your doctor.
Right after the procedure.
- A sterile dressing will be applied to cover the area of the needle stick on your back.
- You will be taken to a room for observation to make sure you’re recovering properly and there are no complications.
- After about 1 hour of observation, you may be released from the recovery room with a prescription for painkillers.
- You will need someone else to take you home—your doctor may not allow you to drive for a few days.
In the first 3-5 days after IDET, your doctor may tell you that you should do the following:
- Use ice packs, nonsteroidal anti-inflammatory drugs, or other pain medications as instructed by your doctor.
- Avoid exertion (no lifting).
- Limit sitting and walking to 10-20 minutes at a time.
- Avoid driving.
During the first week after IDET, it is normal for your back pain to be greater than it was before the procedure. This should pass by the end of the second week.
- Safely returning to work depends on the physical requirements of your job. If your job involves mostly sitting and walking, as in an office setting, you may be able to return within a week, but some soreness may persist. Talk to your doctor about returning to work.
In the early weeks after IDET, your treated disc(s) will continue to heal, and there may be no change in pain. Your doctor may also suggest that you wear a lumbar brace for the first 6-8 weeks for extra support. Unless your job is physically rigorous, you will probably be able to return to work after 1-2 weeks. However, it’s important to remember that your back may still be healing. In addition to following your doctor’s instructions, it may help to follow these suggestions during the first month after your procedure:
- No hard exercise—no sports, no swimming, no use of a treadmill .
- No twisting.
- Limit your lifting to 5-10 pounds.
- Sit no more than 30-45 minutes at a time.
- Drive no more than 20-30 minutes at a time.
- As a passenger, limit car trips to 45 minutes. Use ice packs on your back 1-2 times a day to reduce discomfort.
- Use over-the-counter painkillers (aspirin, ibuprofen, etc) and other pain medications as needed—but be sure to follow your doctor’s guidance.
- Support the small of your back with a pillow or cushion when sitting in a chair or in the car.
- Maintain good posture, and if you have to lift something, lift with your legs as much as possible.
- Stand, walk around, or lie down between periods of sitting.
- Recline your car seat when traveling as a passenger.
- Perform gentle stretching exercises and leg stretches lying on your back on the floor.
After the first week, it is likely that your doctor will recommend that you start walking every day and continue to walk in the weeks to come.
- Start with 20 minutes of gentle walking once a day. When your doctor says it’s okay, increase your walking to two 20-minute sessions each a day.
- Increase your walking time gradually after that. If the level of your pain is not greatly affected, you may be able to increase your walking time up to 1 hour a day by the end of week 4, but don’t overdo it.
- At 2-3 weeks, you can probably begin abdominal brace exercises, lying with your back flat on the floor.
In addition to your doctor’s instructions, follow these general guidelines during the first 2-4 months after IDET:
- Light lifting is allowed at 6 weeks.
- No chiropractic manipulation or massage for the first 12 weeks.
- No traction for the first 12 weeks. Traction is the application of force or pressure by machine or by hand to elongate the spine.
- Physical therapy for the spine is recommended at 8-12 weeks after the IDET procedure. The program should be tailored to your personal needs, depending on your initial diagnosis and the speed of your recovery. Pain reduction typically occurs over a 3-4 month period.