IDET (Intradiscal Electrothermal Annuloplasty)
Annular Tears, as diagnosed by discography, can be treated in the lumbar and lower thoracic spine by heating the area of the tear causing the collagen to shrink around the tear. Also, heat destroys the nerves that have abnormally grown into the disc. IDET uses a catheter (SpineCath) which is flexible and partially steer-able, placed into the disc through a needle. Sedation with fluoroscopic guidance (x-ray) is used for placement of the needle and catheter. After heating for 16.5 minutes, the catheter and needle are removed, and the patient sent home. Post procedure PT begins in approximately 4-6 weeks. Pain relief is usually seen beginning at 8-12 weeks. Heavy lifting and twisting must be avoided for 12-16 weeks afterwards and then resumed only slowly, if at all.
The procedure has been used successfully since 1999 clinically to treat over 25,000 patients in the US alone. Although the success rate varies dependent on the degree of degeneration of the disc, disc height, age, smoking status, post operative instruction compliance, degree of tears, etc, generally approximately 60-70% do receive at least 50% reduction in their pain.
Alternatives include selective endoscopic discectomy with annuloplasty, spinal fusion, nucleoplasty. Risks are bleeding, infection, nerve damage, but are extremely rare.