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http://www.emedicine.com/NEURO/topic707.htm
Intradiscal electrothermal annuloplasty (IDEA) or intradiscal electrothermal therapy (IDET), as it is known commercially, is a new and minimally invasive technique for the treatment of discogenic low back pain. IDET involves the percutaneous threading of a flexible catheter into the disc under fluoroscopic guidance. The catheter, composed of thermal resistive coil, heats the posterior annulus of the disc, causing contraction of collagen fibers and destruction of afferent nociceptors. Although initial clinical studies suggest that IDET might be effective in approximately 70% of patients with chronic unremitting low back pain, its efficacy has not been assessed in randomized controlled clinical trials. The objectives of this article are to review published reports and present a general overview of IDET.
PATIENT SELECTION Section 3 of 11 Click here to go to the previous section in this topic Click here to go to the top of this page Click here to go to the next section in this topic
Author Information Introduction Patient Selection Mechanism Of Action Technical Aspects Postprocedure Care Review Of Published Studies Complications Conclusion Pictures Bibliography
As with other interventional procedures, proper patient selection increases the chances of a favorable outcome. IDET should be considered in patients who have had discogenic low back pain for more than 6 months and who have not responded to conservative treatment.
Ideal candidates are patients with a single affected disc as determined by MRI and discography. Patients with severe radicular symptoms due to a herniated disc or patients with severe spinal stenosis are not good candidates. A severely collapsed disc (>50% of disc height lost) might not respond well to IDET treatment because of technical difficulties in catheter placement and the procedure's questionable effect on high-grade disc injury. Similarly, severely disrupted disc morphology as revealed by discography may not respond well. Patients older than 55 years may have lower success rates because of poorer healing. Cigarette smoking may affect annular collagen tissue and hinder adequate recovery following the procedure.
* Ideal candidates for IDET
o Preserved disc height (>50%)
o Contained disc herniation
o Predominantly axial pain
o Posterior annular deficit
o Motivated/no major psychological issues
o No facet disease
o Younger than 55 years
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