SpineCath* Intradiscal Electrothermal Therapy (IDET)

Provided by NeuroCare Network physicians:
Aaron Calodney, MD
David K. Fletcher, MD
Claire Tibiletti, MD

SpineCath* Intradiscal

The Procedure

Certain lumbar disc problems can be treated with IDET (Intradiscal Electrothermal Therapy). The thermal treatment with the Intradiscal Catheter is intended to treat the protein wall of your disc and reduce the volume of disc material that causes nerve irritation. Your physician feels this procedure could improve your symptoms.

This is a minimally invasive procedure and you will most likely go home the same day. The procedure involves a wire (the catheter) which is guided into your disc through a needle and is heated for about 15 minutes. Then the catheter and needle are removed completely and you will be sent back to recovery.

Pre-operative Preparation

One week before the procedure:

• Stop all NSAIDS, aspirin, and aspirin-containing compounds.
  
• Do NOT discontinue heart, blood pressure, diabetes medications, or other medications prescribed by a physician.

Be sure to tell your physican if:

• You are taking blood thinners or have a history of a bleeding disorder.
  
• You are allergic to iodine (for example shellfish or IVP dye).
  
• You have an infection in any part of your body.

You should not eat the day of your procedure. Clear liquids are permitted. Bring your brace with you to the hospital. Rest well the night before the procedure. Arrange to have someone drive you to and from the medical facility. You may not drive until one week after your treatment.

During the Procedure

An I.V. will be placed in your arm and you will be given sedation. After you are in position on the table, x-ray equipment will identify the area affected. Your lower back, skin, and muscle tissue will then be numbed with local anesthetic.

Electrothermal Therapy

Your physician will then place a needle into your disc under x-ray guidance. Generally, you may experience mild discomfort during this part of the procedure.

The next step is to insert the electrothermal treatment catheter through the needle. Patients typically do not feel any discomfort during this step. However, some patients have reported a mild discomfort in their back when the catheter moves through the disc.

When the catheter position is confirmed by x-ray, the heating element is activated. The heat is slowly increased and will last for 14 to 17 minutes. As the heat increases into the treatment range, you might experience your disc-related symptoms. Your physician will monitor your responses during the procedure to insure that any pain you feel is well controlled.

At the end of the procedure, a small bandage will be placed on your back and you will rest in a recovery area until you are ready to go home.

Post-operative Management: Immediate

For the first 7 - 10 days after your procedure (the immediate post-operative period), you may experience a moderate increase in your normal back pain. Rest, ice, pain medication, and anti-inflammatories will minimize possible discomfort during this time.

Any unusual or new symptoms (for example, fever, rash, or numbness) should be reported to your physician immediately by telephone. Do not expect your usual pain to disappear immediately after the procedure.

If you experience a marked reduction in your pain, do not exert yourself during this time. Exertion may negatively affect the overall outcome. Housework, lifting, or bending should not be done.

Patient Information

Short walks (15 to 20 minutes) are permitted, but generally the first seven days should be spent resting.

You should discuss with your physician your plan to return to work. If your work is sedentary, you can typically return seven days after the procedure. You will schedule follow-up visits with your physician for continuing assessment of your condition.

Post-operative Management : Mid Term

For the first month following the procedure, your disc continues to heal. You may begin to feel a reduction in pain. However, pain reduction usually occurs over 3 - 4 months.

During the first month, you must treat your back carefully. Absolutely no bending, twisting, or heavy lifting. No sport activities including running, biking, golf, tennis, skiing, etc. You do not have to abstain from sexual activity, but be careful not to exert your back.

You may resume back exercises under your physician's guidance. Anti-inflammatory medications and/or pain medication may be prescribed if needed to control discomfort associated with your normal back pain. Applying ice 1-2 times per day (10-15 minutes) is advisable to reduce any lower back discomfort.

Rehabilitation Exercises

Your physician will guide you regarding rehabilitation exercises after your procedure. If you have been performing strenuous rehabilitation exercises before the procedure, you will not immediately return to that level of exercise, but to a more moderate level that will be gradually increased as you improve. Be sure to ask your physician for a post-operative exercise program.

Post-operative Management: Long Term

In the 2nd, 3rd, and 4th months post-operatively, continue to maintain good body mechanics and do not bend improperly. Your physician and physical therapist will help you advance your strength and flexibility. If you plan to return to athletic pursuits, special advanced training will probably achieve your goal.

Your physician may allow you to resume sporting activities 3-4 months after the procedure and may allow you to resume traveling for work or pleasure during this time as well.

In the end…

Your physician has selected this procedure because it offers you a less invasive option for your condition. It may be a promising step in trying to reduce your symptoms.