Discography Intradiscal Treatments

Janet D. Pearl, MD, MSc

Suffering From Pain?

We Can Help

Suffering From Pain?

We Can Help

Suffering From Pain?

We Can Help

Suffering From Pain?

We Can Help

Discography Intradiscal Treatments

Patients with chronic, disabling low back pain caused by degenerating lumbar discs can opt for discography and intradiscal treatments when conventional pain management therapies fail to provide adequate pain relief. The most common of these treatments is electrothermal therapy, known as the intradiscal electrothermal therapy (IDET).

Discography enables the physician to detect the pain-causing disc. The suspected disc along with a control disc(s) are injected with x-ray contrast to determine whether the usual chronic pain is reproduced. A follow up CT scan is done after the procedure to visualize the contrast in the disc, looking for tears and leaks. Once the offending disc is identified, IDET or a surgical option is considered. The IDET procedure involves placing a flexible electrode into the painful disc annulus and heating it to a high temperature to coagulate adjacent tissue. Simultaneously, the pain sensing nerve fibers within the disc are destroyed by the heat, providing pain relief.

IDET is carried out on an outpatient basis. Following an IDET procedure, patients often experience an increase in pain symptoms for the first day or two. These symptoms can be controlled with anti-inflammatory pain medications. Pain relief is experienced about 6 weeks after the procedure.

As with any invasive procedure, there is a risk of bleeding, infection and pain and numbness at the injection site. Other complications may include increased low back pain, headache, cerebral spinal fluid leak, catheter breakage, nerve root injuries, and an increase in size of herniation.

The success rate of IDET in the initial study was very high with significant pain relief (>50% reduction) and improvement in sitting tolerance, and quality of life lasting through the two year follow up after the procedure in those patients studied. (Spine. 2002 May 1;27(9):966-73; discussion 973-4.) Although further studies have not reproduced the same results, (The Spine Journal , Volume 3 , Issue 6 , Pages 502 – 509), utilizing IDET in a highly selective manner has been shown to produce successful results in 75% patients. (J Spinal Disord Tech. 2008 Feb;21(1):55-62).

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