Intradiscal Heat Therapies: IDET and Biacuplasty
Intradiscal heat therapies include Biaculoplasty and IDET and can treat chronic pain in the lower back. The physician uses heat to reduce the sensitivity of nerve fibers in a spinal disc. More than one disc may be treated. Both techniques provide alternatives to lumbar fusion for well-selected patients.
Good candidates for disc heating include those patients with one or two pressure-sensitive lumbar discs that are early in the degeneration phase and are mostly intact with normal or near normal disc height. Lumbar imaging (MRI or CT) and lumbar discography are tests that will determine whether disc heat treatments are appropriate for you. Below is a description of Biaculoplasty and IDET, similar procedures that may relieve disc pain.
Intradiscal Electrothermal Therapy (IDET)
Studies on IDET have proven the procedure to be effective for appropriate patients, with about 75 percent of those undergoing treatment reporting satisfactory outcomes of reduced pain and increased mobility. IDET is also a cost-effective method for low back pain treatment, especially when compared to pricey spinal fusions.
How IDET Works
Age or injury may produce tears or cracks in the walls of intervertebral discs. These tears can become filled with small nerve endings and blood vessels and, for many patients, are the source of chronic pain. In theory, the IDET procedure thickens and strengthens the disc wall by applying controlled heat to the disc wall. This heat lesion also destroys pain-causing nerve fibers within the disc, eliminating pain from that source.
First, a small tube called a catheter is inserted into the disc with fluoroscopic guidance. The catheter is then maneuvered to achieve a 360-degree penetration. Heat is introduced into the disc through the catheter, gradually progressing around 150° F to approximately 200° F. The entire IDET procedure is performed on an outpatient basis and takes approximately one hour, with an additional hour of recovery time.
Some patients report immediate pain relief, but it is more likely that significant relief and improvement in function occurs as the disc heals. This process generally takes four to twelve weeks. Patients typically return to basic work within one week of the procedure. After six weeks, more strenuous physical activity, in combination with a formal spinal-strengthening program, may begin. Patients can be expected to be fully healed six months after the procedure.
View this video to learn more about IDET.
Who Can Benefit from IDET?
Candidates for IDET are those who have chronic discogenic back pain that has not responded to aggressive, non-operative therapy. Usually, patients have been experiencing lumbar pain for at least six months, have had a normal neurologic exam and have undergone an MRI that showed no neural compressive lesion. Discography is essential in confirming that the disc itself is the source of the pain, identifying the number of affected discs and locating tears within the disc(s). IDET is not indicated for severe disc degeneration, nerve compression, spinal instability or spinal stenosis.
Biacuplasty is used to treat discogenic pain or disc-related pain. Discogenic pain is conventionally treated with surgery, i.e. spinal fusions and disc replacements. Unfortunately, these types of surgery are extremely invasive with extensive recovery times.
Biacuplasty is an easy, effective and minimally invasive method for treating discogenic pain. In successful cases, patients are able to avoid surgery and return to the activities they love without a painful postoperative recovery.
How Disc Biacuplasty works
Disc biacuplasty is an innovative and highly sophisticated treatment that uses a TransDiscal System (TDS) to treat chronic low back pain originating in the spinal disc. This condition, also known as discogenic pain, is treated using radiofrequency technology to disable the sensory nerves that may be responsible for the pain.
The TransDiscal System (TDS) is a medical device that enables the back of the disc to be heated to high enough temperatures to ablate the nerves inside that are transmitting pain, while maintaining low enough temperatures to prevent damage to surrounding tissues. The TDS uses two electrodes, located at the ends of two thin probes, which are placed on both sides of the back of the intervertebral disc by inserting them through the skin into the disc using x-ray guidance. Radiofrequency current flows in the disc between the two electrodes, heating the tissue in the disc to the desired temperature.
View this video to learn more about Disc Biacuplasty.
Who can benefit from Disc Biacuplasty?
If you have chronic discogenic back pain, you may benefit from disc biacuplasty. However, only a qualified physician can properly diagnose you and suggest appropriate treatments. Talk to your pain management physician to see if disc biacuplasty is right for you.