Annuloplasty

Intradiscal Electrothermal Annuloplasty (IDET)

The bones (vertebrae) of the backbone are separated by spongy discs that cushion and act as shock absorbers to the backbone. With age, these discs can wear-out and tear. This causes the adjacent nerves to come in contact with the central part of the disc (nucleus), or the nucleus to move out and press against the adjacent nerves, leading to irritation and pain. Intradiscal electrothermal annuloplasty (IDET) is a treatment for chronic lower back pain related to spinal disc damage or degeneration.

You are an ideal candidate for an IDET procedure if you have lower back pain for at least 6 months, which gets worse when sitting, does not radiate to the legs, and have received no relief with conservative treatment. IDET is not recommended if you have severe disc degeneration, narrowing of the spinal column (stenosis), an unstable spine (spondylolisthesis) or any medical condition, including pregnancy, where most surgeries are not recommended. Further to this, the need for IDET is determined after a diagnostic technique called discography is performed, in which a dye is injected into the disc and X-ray imaging is used to examine the extent of disc abnormality.

IDET is performed under sedation and local anesthesia. Your doctor uses a hollow needle to carefully place a catheter containing a heating element into your spinal disc, under the guidance of live X-ray imaging (fluoroscopy). Once in position, the heating element is gradually heated to 194°F (90°C). This destroys the invaded nerve fibers, hardens the disc tissue and seals the tears. Antibiotics are administered to prevent disc infection.

IDET does not produce immediate pain relief. There may initially be pain for a few days. Stretching and exercise should be gradually introduced following IDET. You must avoid strenuous activities for five to six months, and lifting, bending or sitting for a long time at least 2-3 months after the procedure. Although rare, IDET like all surgical procedures may be associated with certain risks and complications such as infection, and disc and nerve damage.



HARVARD MEDICAL SCHOOL ASHPP PENN SIS AMA NASS aaPM&R ISASS - The International Society for the Advancement of Spine Surgery