IDET Treatment For Back Pain

Intradiscal Electrothermic Therapy (IDET) is a relatively new, minimally invasive, procedure developed to treat chronic low back pain due to a spinal disc problem. It may be recommended for people who have had chronic disc related low back pain for at least 3 to 6 months.

It can be used to treat:

• Small disc herniations
• Internal Disc Tears
• Mild disc degeneration which is limited to one or two levels

Degeneration of the disc

Experts believe some cases of persistent disc pain may be caused by nerve fibers that have migrated from their normal location in the outer layers of the disc into its interior. The degeneration of the disc with age or injury is characterized by the breakdown of the tough outer layers of the disc, allowing fissures to develop in its walls. Filled with blood vessels and small nerves, these fissures can become a source of chronic pain in many patients.

Injury to the disc

If there has been a back injury which compressed the intervertebral disc, causing it to bulge or herniate, material from its center will protrude, stimulating pain sensors within the disc. This material from the nucleus of the disc is irritating and adds to the pain.

Before an IDET procedure is done, a discography should be completed to clearly identify the problem. IDET is not recommended for:

• Severe disc degeneration
• Spinal stenosis
• Spinal instability as with spondylolisthesis

The Discogram is the primary diagnostic tool although an MRI (Magnetic Resonance Imaging) may also be done. With a Discogram, a needle is placed in the affected disc and a small amount of dye is injected. This provides information on the disc structure and pain source. It is very important that an accurate diagnosis is made and the disc identified as the source of the pain. IDET is not recommended for pain symptoms due to problems with spinal structures, such as nerve roots or spinal joints. It is important that the disc itself be identified as the primary source of pain.

Before the Surgery (Preoperative)

One week before the surgery, the following should be done:

• Stop taking NSAIDs (Nonsteroidal Antiinflammatory Drugs), aspirin and aspirin compounds.
• Continue taking any prescribed heart, blood pressure or diabetic medications.
  

• Be sure to alert your physician if you are:
• Taking blood thinners or have a history of a bleeding disorder
• Allergic to iodine (can’t tolerate shellfish or allergic to IVP dye)
• Having any illness, elevated temperature or sign of infection

• DO NOT eat the day of the procedure.
• Your physician may permit a small amount of clear soup, broth or juice. Be sure to ask.
• Arrange to have someone drive you home.

The Procedure

• An IV will be started and you will be given a mild sedative.
• You will be positioned on the x-ray table and given a local anesthetic.
• The doctor will insert a hollow needle into the disc. The process will be visualized on fluoroscopy.
• An electrothermal catheter or heating wire is inserted through the needle and positioned in the disc.
• The wire or catheter is slowly heated to about 194° F for about 15 minutes. This heat causes the disc walls to thicken and heal small tears as it destroys the nerve endings.
• An antibiotic may be given IV or directly into the disc to prevent any infection.
• The needle will be removed and a dressing applied to your back.
• You will be observed in a recovery area until you are ready to go home.

After Surgery

• Pain may be more noticeable after the procedure, lasting 2 or 3 days.
• Physical therapy will be prescribed.
• Restrict bending and lifting during recovery and avoid sitting for long periods of time.
• A lumbar support may be prescribed for up to 8 weeks.
• Walking and easy stretches are recommended.
• Activities such as swimming, running or tennis should not be resumed for at least 6 months.

This is the least invasive type of spinal procedure. Complications are rare but possible risks include:

• Weakening of spine
• Disc infection
• Nerve damage
• Disc damage

Pain may remain for up to 3 months after the procedure. There have been no large long term studies to evaluate the effectiveness of IDET. Brought to you by Lake Worth Chiropractor.

Discitis and Back Pain

Discitis is relatively uncommon but it usually affects children under the age of ten. It is a low grade infection, usually caused by staphylococcus or a virus. It affects the disc space between two vertebrae and develops very slowly. Medical experts say this should be viewed in the same category as vertebral oseomyelitis (infection within the vertebrae). It can lead to severe, debilitating, neurological damage.

Disease Process

The infection does not start primarily in the in disc space but migrates there from other sources in the body. Urinary tract infections, pneumonia, and soft tissue infections are believed to be the most common sources. Often, no site of infection is discovered. The lumbar (lower) back is affected most often, followed by the cervical spine (neck) and last is the thoracic spine (upper back). Some post-surgical patients have developed the disease weeks after their operation, and, in their case disease diagnosis is not delayed. They rarely develop neurological deficits.

The edges of the disc erode and the degree depends upon the amount of infection and destruction within the disc. These areas become calcified, once healing begins, and, eventually, there is an interbody fusion, when healing is completed

Disease in Adults

This infection has a slow, insidious onset which can result in diagnosis being delayed for months. Pain in the back and neck are the most common complaints and movement makes it worse. Because the symptoms are similar to those of back strain, there is usually a delay in seeking medical attention. A doctor is often not seen until the sufferer develops an elevated temperature and chills, with weight loss. This delay can lead to a severe condition and the mortality rate (death rate) ranges between 2% to 12%. It more commonly affects males, with a ratio of 2:1 that has gone as high as 5:1.

Disease in Children

The onset is often more sudden, acute, and the back pain is accompanied by a refusal to walk, sit up, and there is extreme irritability. There may be localized tenderness over the spine and decreased range of motion.

Common Symptoms in Adults And Children

• Elevated temperature
• Chills
• Sweating
• Feeling of fatigue
• Loss of appetite
• Localized tenderness of spine
• Pain may travel to other parts of the body, including abdomen, hip, leg, groin.
• Movement aggravates pain.

Diagnosis

• Laboratory studies
• Sputum cultures may be done to isolate bacteria for diagnosis.
• Blood Culture
• X-rays of spine may show narrowing of disc space.
• Nuclear scan of spine
• CT Scan (Computerized Tomography)
• MRI (Magnetic Resonance Imaging)
• Echocardiogram can identify bacterial endocarditis which is responsible for some cases of discitis.
• Needle Biopsy of painful area to obtain tissue for culture

Treatment

• Antibiotics specific to kill organism once it’s identified
• IVs for hydration and supportive care
• Immobilization is necessary.
• Usually 2 weeks of bedrest
• Back brace when patient is able to ambulate
• This allows vertebrae to fuse in an aligned position.
• Bracing may be necessary for 3 to 6 months following treatment to avoid collapse of vertebrae and development of kyphosis ( curvature of spine – ‘round back’)

Discitis occurrence in the US ranges from 1 in 100,000 to 1 in 250,000 but in less developed countries, it is more common. In some parts of Africa, 11% of all patients seen for back pain were diagnosed with discitis.

(Brought to you by Lake Worth Chiropractor)