IDET – a new procedure for discogenic back pain management (Research article)

IDET (Intradiscal Electrothermal Annuloplasty) provides a new alternative to other surgical procedures for patients who suffer from back pain caused by certain types of disc problems.

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

What is IDET and what does it do for back pain management?
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.

How does IDET work?
The IDET process takes about an hour to complete and is done as follows:

• The procedure is performed with a local anaesthetic and mild intravenous 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 (see Figure 1)

• 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 (see Figure 2).

• 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.