Intradiscal Electrothermocoagulation also known as annuloplasty and abbreviated as IDET is a new innovation employed in the management of low back pain.
Intradiscal electrothermocoagulation is a procedure used in patients experiencing pain in the lower part of their back, confirmed by positive discography studies, with a disk identified as the main source of the pain.
There are other facts that are included in the procedure’s criteria such as:
1. The involved patients should describe or have a history of low back pain for over a period of 6 months that has not responded to other conservative treatment methods such as trial transforaminal nerve root or epidural injections of steroids.
2.The disk height at the pain site should be greater or equal to 50% of normal disk height level.
3. The treated patient should not have symptoms in the lower extremity that are associated with the pathology at the disk not unless these findings are caused by other factors or conditions and are independent of the situation at the disk level.
4. The CT or MRI scan of the targeted area should not show frank disk herniation, though disk bulges or protrusions might be present.
5. A patient becomes a strong candidate if there is a positive provocative discography at the level in considerations well as an asymptomatic disc control in the adjacent area.
6. The patient being treated has presentations associated with short period of sitting that are characterized by low back pain as opposed to pain that emanates from long sitting periods.
This procedure is normally carried out using a catheter which is inserted into the pulposus compartment through a posterolateral approach.
In the Intradiscal electrothermocoagulation process, an electrothermal device is threaded and inserted anteriorly in the wall of the nucleus and then posteriorly to the walls of the annulus.
This device is then heated up to about 90 degrees centigrade for a period of about 12 minutes 30 seconds and sustained at this temperature for an additional 4 minutes.
The main aim of this procedure is to hit the collagen in the disk wall and raising the temperature to desensitize the nerve ending. The hit on the collagen will later be useful in altering collagen protein which will provide the contraction and the closure of the wall fissures of the disk that were identified in the discography procedure.
It has been identified that this procedure may result in the reduction of disc bugles and this will greatly contribute to the relief of pain.
The specific pain relief method has not been scientifically determined but this procedure is highly successful in the treatment of patients that meet the above criteria.
It is also important to note that this procedure can only be performed on patients who have stability and do not show signs of Spondylolisthesis that is worsening.
IDET has replaced conventional treatment methods used in the treatment of discogenic low back pain and this will minimize morbidity and reduce the incidents of complications arising from the treatment of lower back pain.