Center for Pain Management

Intradiscal Electrothermal Therapy (IDET)

With age, or due to injury, cracks or fissures may cause fissures to develop in the wall of the intervertebral disc. Filled with small nerve endings and blood vessels, these fissures are a chronic source of pain in many patients. Additionally, the inner disc tissue (nucleus) will frequently cause the disc to bulge or herniate into these fissures in the outer region of the disc, likewise stimulating pain sensors within the disc. Intradiscal Electrothermal therapy is a minimally invasive treatment in which the physician applies controlled levels of thermal energy (heat) to a broad section of the affected disc wall. This heat contracts and thickens the collagen of the disc wall, and raises the temperature of the nerve endings. Therapy may result in contraction or closure of the disc wall fissures, a reduction in the bulge of the inner disk material, and a desensitization of the pain sensors within the disc.

Intradiscal Electrothermal therapy acts exclusively upon the tissues of the disc itself, and should not be expected to relieve symptoms arising from other spinal structures, such as nerve roots or spinal joints. It is therefore very important for your physician to diagnose that the disc is the primary source of your back pain. In addition to a clinical examination, your physician may use Magnetic Resonance Imaging (MRI) or injections of dye into the disc (discography) to confirm the diagnosis. Once satisfied that one or more discs are the primary source of your lower back pain, your physician may recommend IDET therapy.

IDET therapy is performed on an outpatient basis. Local anesthesia and mild sedation are commonly used to reduce patient discomfort during the procedure. Patients are awake and alert so that they can provide important feedback to the physician when asked. With the guidance of x-ray images, the physician will advance a needle into the disc.  A catheter is passed through the needle and into the disc. Once the needle is in the appropriate position, the temperature of the heating section of the catheter will be increased gradually, raising the temperature of the disc wall.  During this heating, the physician will closely monitor the patient’s condition and comfort level.  Patients will most likely feel a reproduction of their usual lower back pain. This is an indication that the heat is being applied to the appropriate areas.  Once the therapy is completed, the catheter and needle are removed.