IDET or intradiscal electrothermal annuloplasty is used to treat tear in the outer wall of a disc. When a disc tears, some of the fluid or disc material can leak out and irritate the nerves in your spine. This fluid can cause inflammation and thereby pain. To control the pain the tear needs to be sealed so the irritant is once again contained within your disc. In addition, when the disc tears, small blood vessels and more importantly nerves begin to grow in and around the tear, causing the back pain associated with this condition. This treatment, which is an alternative to open back surgery, involves the insertion of a needle into the center of the disc. We use the needle to introduce a coil that is steered to the location of the tear. A small section of this coil or wire can be heated using radiofrequency energy. Heating of the outer wall of the disc causes controlled scarring, which will seal the tear in your disc. The heating of the disc may also destroy the nerve endings that your body grew into the tear. In general the results with IDET have been good in properly selected patients. One of the major benefits to this procedure is that if it doesn’t work, you still have the option of open back surgery.
Unfortunately this therapy has been often misused and therefore many physicians do not believe in its effectiveness. Instead of only offering the treatment to patients who fit the strict criteria, patients were given this option even when they weren’t ideal candidates.
Patients who have both a disc herniation and an annular tear typically require treatment of both portions of this injury for an optimal outcome. Dr. Kloth feels strongly that to prevent the disc from re-tearing, any coexisting disc herniation should be removed to reduce the pressure on the outer wall of the disc. In addition, once the disc herniation is decompressed, using a percutaneous discectomy approach, strengthening of the outer wall with IDET, can help prevent re-herniation or recurrent injury of the disc. Combining these minimally invasive procedures can treat both the patient’s herniated disc and annular tear, and thereby enhance the results of each treatment.