IDET (Intradiscal ElectroThermal Therapy) is a procedure, used in a select group of patients with back pain, in which a special catheter is placed into the disc. Controlled levels of heat are then applied into the disc using this catheter. The heat contracts and thickens the collagen of the disc wall and may reduce the bulge of the inner disc material. This ultimately leads to a reduction in pain in approximately 50% of people, which is the approximate success rate of surgery. The healing process takes 12 to 16 weeks after the procedure at which point pain relief is usually experienced. IDET is best suited to people who have pain located primarily in the low back who have not improved with more conservative therapies including medications and physical therapy. You should have a MRI that shows that at least 50% of the disc height is preserved. Usually a discography (a test where dye is injected into the disc and reproduction of pain is tested) is performed to identify disc(s) involved and that the disc is a cause of your typical back pain. There are other limiting factors, so each individual case should be reviewed with your Pain Doctor.
The main risk of the procedure, though it happens less than 1% of the time, is diskitis. Diskitis is an infection in the disk that can lead to an infection in the spine. Every effort is made to prevent this from happening – antibiotics before the procedure, antibiotics injected into the disc during the procedure, sterile technique, etc. There is also a chance of what is called a paresthesia – a shooting, “electric-shock” type pain. If this occurs during the heating phase of the procedure, the temperature of the catheter will be reduced. If the paresthesia continues the catheter may need to be re-positioned and/or the procedure may need to be stopped. As with most procedures there is a remote risk of bleeding, infection, or allergic reaction to the medication used. As the procedure is in an area where there are nerves, there is the added remote risk of worsening of the pain, nerve injury and/or paralysis.
The procedure is done under light conscious sedation (intravenous medication that helps to relax you and reduce discomfort). You need to be awake and able to feel pain for this to be a safe procedure. Your skin will be numbed with a local anesthetic. This is usually felt as a stinging/burning sensation. As the catheter enters the disc you may have discomfort/pain. During the heating process, you may feel discomfort/pain in your back. If you feel pain that radiates into your legs, the temperature will be decreased. This will usually stop the leg pain. If the pain continues in the leg, the catheter may need to be re-positioned and/or the procedure may need to be stopped.
You will need to arrive 1 hour before your actual procedure time so that an intravenous can be started and an antibiotic given. (Let the doctor know if you have any allergies to antibiotics). It takes about 45 minutes for the antibiotic to get to the disc – you will wait in the recovery area during this time (you may want to have your ride keep you company or bring something you enjoy doing – reading, crocheting, etc.). After signing a consent form and checking your blood pressure, the intravenous will be started and the antibiotic given. About 45 minutes to 1 hour later you will be escorted into the fluoroscopy (x-ray) room. You will be asked to lie on the table on your stomach. The back is cleansed with an antiseptic soap. Sterile drapes are placed. Light sedation will be given around this time. The skin is then anesthetized (numbed) with a local anesthetic. This is felt as a stinging/burning sensation. Using x-ray guidance, the introducer needle is placed followed by placement of the IDET catheter. Once proper placement is confirmed by x-ray – the heating process will begin. This stage takes from approximately 13 to 20 minutes depending on the temperature needed. It is important to let the doctor know if you begin to get pain that goes down your leg. The doctor will then determine whether the temperature needs to be lowered, the catheter re-positioned, and /or the procedure stopped. Once the heating phase is completed, antibiotics will be injected directly into the disc. The needle will then be removed. Your skin will be cleansed and a bandage will be applied. (The bandage can be removed on the next morning). Your blood pressure will be checked and you will be discharged to leave with your ride after M.D. authorizes your discharge.
You can expect an increase in your pain post-procedure that may take several days to begin to subside. Your doctor will discuss pain medication with you. Ice is also helpful. You will see a physical therapist prior to the procedure to be fitted for a corset. You will need to wear this for 6 weeks after the procedure. You will be given instructions on activity restrictions that begin with 1 – 3 days bed rest post-procedure and gradually increase with the assistance of physical therapy and an exercise program. This takes place over many months. Ask your doctor if you have any specific concerns.
You may NOT drive for the remainder of the day after your procedure. No heat is to be used on the injection area for the remainder of the day. No tub bath or soaking in water (pools/Jacuzzi, etc) for the remainder of the day.
If you experience severe back pain, new numbness or weakness of your legs, loss of control of your bladder or bowels, or have signs of infection (temperature greater than 99.9º , drainage, redness/heat at insertion site) – call IMMEDIATELY.
ON THE DAY OF YOUR PROCEDURE, PLEASE DO THE FOLLOWING:
♦ Take all blood pressure pills & heart medications prior to the procedure with a sip of water at least 3 hours before your requested arrival time. Your vitals must be stable to have the procedure.
♦ Have a responsible person to take you home.
♦ Arrive at the requested procedure time. Please do not be late or your procedure may be cancelled.
ON THE DAY OF YOUR PROCEDURE:
♦ Do not take ANY of the following 5 days before your procedure: Coumadin
♦ Do not take ANY of the following 7 days before your procedure: Plavix
♦ Coumadin must be stopped prior to the injection. You must have a normal INR prior to the injection. Do not stop the drug by yourself.
♦ Eat or drink 6 hours before the procedure.
NOTE: YOUR PROCEDURE WILL BE CANCELLED IF:
- You have an active infection, flu, cold, fever, or very high blood pressure.
- You do not have a responsible driver to take you home, arrive late for your procedure, or unable to follow the medication / fluid restrictions.
Call the office at (513) 860-1039 for procedure related questions.