Intradiscal Electrothermal Therapy

Information for Adult Patients -  Intradiscal Electrothermal Therapy (I.D.E.T.)

Your clinician has referred you for IDET treatment. IDET is an X-ray guided minimally invasive procedure in which the Radiologist applies controlled levels of heat to the intervertebral disc. This is achieved through a needle using a specially developed heat probe. The procedure acts exclusively upon the tissues of the disc itself and is directed at treatment for cracks, fissures and tears within the disc. The procedure does not relieve symptoms arising from other spinal structures such as nerve roots or facet joints.

Patient Preparation

One week before the procedure. Stop all non steroid anti-inflammatory drugs such as aspirin, aspirin containing compounds, Ibuprofen, Voltorol or other similar medications.

Continue heart, blood pressure or diabetes medication.

Contact us if you are taking Warfarin, Heparin or any other blood thinning medication.

Contact us also if you are allergic to Iodine (for example the dye used in injections for kidney tests etc.).

The procedure may have an increased risk of infection if you are known to have an infection in any part of your body e.g. Tooth abscess, synovitis, chest infection. Please contact us should this be a problem.

Rest well on the night before the procedure. You should not eat on the day of the procedure although you may drink clear liquids. This is a Day Case procedure but you will receive sedation and will require someone to drive you to and from the hospital. You should not drive until the day after the treatment.

The Procedure

A drip will be placed in your arm and you will be given a light sedative. You will be given intravenous antibiotics and some painkillers but you will not actually be quite asleep. You will be laid on the X-ray table, usually on your tummy but possibly lying on your side. Your low back and muscle tissue will then be numbed with local anaesthetic.

A needle will then be placed into the disc under X-ray guidance and then the treatment catheter inserted through the needle. Some patients report some mild discomfort when the catheter goes into the disc but most patients find this painless. The catheter position is confirmed by X-ray and then the heating element is activated. Heat is slowly increased and will last between 14 and 17 minutes. You will be asked questions during the procedure to ensure that any pain you feel is well controlled so it is possible you might experience your typical low back pain as the procedure goes on. Once the heating protocol is completed the catheter will be removed, a small dressing applied and you will be able to rest in the recovery area until you are ready to go home.

Post Operative Management

The heat-treated disc requires time to heal. Symptom improvement is not immediate and some patients do not notice relief of their symptoms for 12 to 16 weeks. Most patients experience an increase in their typical back pain immediately after the procedure which then gradually subsides over the next 7 days. Most patients return to the pre-treatment pain level between the first and second weeks of the procedure.

In the first three days it is best to rest and take analgesics as you need them. You should not exert yourself during the first week because strain on the disc during this time could cause the disc to bulge outwards. No housework, lifting or bending should be done. If your work is sedentary (e.g. Office work not involving lifting) you can return to work after the week so long as your pain allows it.

After the first week you may feel a reduction in pain and the disc will continue to heal but you must treat your back very carefully. Please restrict bending, twisting and lifting. No sporting activities at all are allowed for the first month.

I.D.E.T. Rehabilitation Guideline for Activity

Rest
Day 1 to Day 3 rest (preferred positions: reclining, walking or limited sitting upright depending upon which is most comfortable).

Corset
You may wear a corset if you find it comfortable in order to limit activity.

Return to work
Recommendations on an individual basis. The following is a guide:-

Day 7 to day 14 resume sedentary work.
Month 3 onwards resume manual work depending on functional capacity.
Heavy work should be avoided for 5 to 6 months.
Driving
Day 1 to day 5 driving may be resumed. (Short journeys only).

Light housework
Week 1 light housework may be resumed. (Light dusting, no lifting).

Sitting
Week 1 if tolerated 20 to 45 minutes
Week 2 if tolerated 20 to 45 minutes and then increase gradually within own levels of tolerance.

Lifting
Week 1 & 2  - 0 to 10lbs. (4.5kg).
Week 3 to 3 months up to lips (gig).

Bending
To be avoided.
You must maintain good body posture and mechanics during all activities.

Twisting
To be avoided.
You must maintain good body posture and mechanics during all activities.

Walking
Week 2 begin walking daily and then increase gradually within your own levels of comfort. Attempts should be made to advance walking to a minimum of 20 minutes per day.
Week 3 to 6 - 15 to 20 minutes three times per day.

Massage
Weeks 1 to 8 No massages.

Manipulation/traction
No manipulation and traction for 6 months.