Alternatives to Spinal Surgery Part 1: IDET
Tuesday, April 23, 2002 | 983 | 0 | min read
This is the first of a series of articles on Non-Invasive Surgical Alternatives for the Treatment of Low Back Pain by Dr. Michael Minehart.
Chronic Low Back pain changes you and your life. Many of my patients are either left with the decision to live in chronic pain or undergo spinal fusion surgery in an effort to remove the disrupted disc and establish a new more stable foundation.
Recent research has pinpointed the lumber disc as the pain source in the majority of patients suffering with chronic low back pain. As the discs begin to degenerate they lose the water content from the gel-like nucleus found in the center of the disc called the nucleus. As the nucleus loses water, the wall of the disc, or the annulus, begins to bulge. The bulging annulus is weakened and can become torn either due to a specific injury such as bending or twisting, or from the cumulative trauma of daily life.
When the annulus tears it causes pain. The body attempts to heal the tears by sending small blood vessels to the site that carry small nerve fibers. Due to the lack of an adequate blood supply the healing process fails. The disc becomes a pain source.
Pain is generated whenever the disc is asked to perform work - such as bending or sitting. Bending or sitting places a heavy load on the disrupted disc thus eliciting pain.
Many patients can be treated effectively with dynamic stabilization exercise training, x-ray guided cortisone injections, acupuncture, adherence to proper body mechanics, medications, and the passage of time to allow the body itself to heal. Unfortunately, a substantial number of patients remain symptomatic after 12-18 months of care.
IDET was developed as an option to spinal fusion. IDET is the trademark name for IntraDiscal Electro Thermal Therapy, also known as Annuloplasty.
With IDET the disc can be treated without an incision and without destroying tissue. The IDET technology uses a temperature controlled heat source that is imbedded in a thin catheter that is guided by x-ray into the disc. The heat at 60-70 degrees Celsius (approximately 149 degrees Fahrenheit) is controlled by a microprocessor and delivered to the disc wall. This heat range should cauterize the small nerve fibers imbedded in the disc wall (ie the small blood vessels that have grown into the disc) and shrink the collagen protein material that makes up the disc wall. The collagen shrinkage should improve disc function and the cauterization of the nerve fibers should relieve pain.
IDET is not however without risks. Injury to the nerve, infection and worsening of the clinical condition are possible but have not been seen in over 500 cases treated and followed at Stanford Hospital over the last 3 years.
Also, IDET is not for every low back pain sufferer. Some patients with chronic disabling low back pain may be candidates for a diagnostic evaluation to determine if a disrupted disc is the cause of their pain. If this can be accurately pinpointed some of these patients may be candidates for an IDET procedure.
Other alternatives to surgery will follow in future articles.
Michael Minehart, MD, is the Department of Anesthesiology Chair at Santa Teresita Hospital and Founder of the Advanced Pain Institute located in Duarte, CA, which specializes in the treatment of the chronic pain sufferer.