What is the efficacy of intradiskal electrothermal therapy (IDET) for 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

A study by Andersson et al showed that IDET was effective as spinal fusion for improvement in symptoms without the attendant complications attributed to spinal fusion. [205] A 2004 randomized, placebo-controlled, double-blind, prospective trial by Pauza et al showed that improvement in the IDET treated group was significantly better than a sham procedure. Of the patients treated with IDET, 40% had obtained 50% pain relief at 6 months. [207] On the other hand, a randomized, placebo-controlled, double-blind study by Freeman et al showed no improvement in either the treatment or comparison group at 6 months. [208]

Comprehensive, evidence-based guidelines published in the July/August 2009 Pain Physician reviewed the effectiveness of IDET in all published, randomized, and observational studies and concluded that relatively high quality evidence was available for only weak recommendations for using IDET as a treatment method depending on the clinical situation. [209] Complications of IDET included catheter breakage, nerve root injury, postprocedure disk herniation, progressive disk degeneration, cauda equina syndrome, vertebral endplate osteonecrosis, epidural abscess, radiculopathy, and spinal cord damage. [209]

Percutaneous RF posterior annuloplasty involves the placement of a wire within the annulus itself. The evidence for RF posterior annuloplasty is limited for short-term improvement and indeterminate for long-term improvement of chronic diskogenic LBP. [136] The evidence is moderate for short-term and limited for long-term relief using percutaneous laser diskectomy for pain reduction. [136] Nucleoplasty has been shown to provide limited short- and long-term relief. [136] The evidence is moderate for short-term and limited for long-term relief using automated percutaneous lumbar diskectomy. [136] The evidence for percutaneous disk compression using the DeKompressor is limited for both short- and long-term relief.


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