What is the role of intradiskal electrothermal therapy (IDET) in the treatment of low back pain (LBP) and sciatica?

Updated: Aug 22, 2018
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

Intradiskal electrothermal therapy (IDET) is a minimally invasive technique in which the annulus is subjected to thermomodulation. These procedures are postulated to shrink collagen fibers and coagulate neural tissues, thereby alleviating the nociception produced by mechanical loading of a painful disk. [137] IDET is performed using radiographic placement of a 17-gauge introducer needle through the posterior annular wall into the nucleus pulposus of symptomatic disks as determined by diskography. A navigable catheter with a temperature-controlled, thermal-resistant coil is passed through the needle so that it curls along the posterior inner annulus. Catheter temperatures are slowly raised to 90°C, causing thermocoagulation of intradiskal and inner annular collagen, as well as associated nociceptors. A reduction in pain symptoms may result from denervation or shrinking and remodeling of the diskal structure, or both. [200]

Karasek and Bogduk introduced a flexible electrode into a diskography-symptomatic disk with internal disk disruption. [201] The electrode was passed circumferentially along the inner annulus to heat and coagulate annular collagen and nociceptive nerve fibers. Of the 35 treated patients, 23% achieved complete pain relief and 60% improved. The improvements were sustained at 6 and 12 months. Seventeen patients comprising a parallel comparison group received physical rehabilitation program alone. None of the participants in the comparison group reported benefit, except 1 patient who experienced a dramatic pain reduction. [201] At 2-year follow-up, 54% of the patients in the treatment group had achieved at least 50% relief with concomitant functional improvement. [202]

The evidence for IDET includes several recent systematic reviews. [203, 204, 205, 206, 207, 208, 209]

Appleby et al published a systematic review of the literature from all available studies and concluded that there was compelling evidence for the relative efficacy and safety of IDET. This meta-analysis showed significant improvements in pain intensity, physical function, and disability; however, the lead author was an employee of the device manufacturer. [206]


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