Smith & Nephew - IDET - For Patients: Frequently Asked Questions

If you have discogenic lower back pain, or if you know someone who does, you may have questions about the condition and its treatment with the IDET* procedure. While some of your questions may be answered here, the best way to gather information you need is to consult your doctor. Together, both you and your doctor can decide upon a treatment plan that is right for you.

You may also wish to download an IDET procedure patient brochure.

1. What is the IDET procedure?

IDET (Intradiscal Electrothermal* Therapy) is an outpatient procedure used to treat patients with chronic disc-related lower back pain who have failed a program of nonoperative therapy.

2. What is a slipped disc, and is IDET used to treat slipped discs?

A “slipped” disc (also called a herniated or prolapsed disc) is a degenerating disc that has begun to bulge out into the space between its two associated vertebrae. The bulge can push against a spinal nerve and cause pain.

The bulge may involve only the outer layer (anulus) of the disc, or it may be so severe that it also contains the nucleus. The IDET procedure can treat mildly prolapsed, unruptured discs that have kept their basic shape and structural integrity, but a badly prolapsed, herniated, or ruptured disc is a contraindication for the IDET procedure.

3. What does the IDET procedure involve?

A hollow needle is inserted into the disc that the doctor thinks is causing your pain.

A wire-thin probe is then inserted through the needle and into the disc.
Real time x-ray imagery (video fluoroscopy) is used during the procedure to help the physician put the probe into the correct position.
When the probe is in place, the temperature of its tip is gradually increased, heating the disc internally for approximately 15 minutes.
The heat may inactivate pain receptors in the disc and modify disc tissue to seal internal cracks and tears and improve disc stability.

After the procedure, a small amount of antibiotic may be injected into the disc to prevent infection, and a sterile bandage is placed over the area of the needle stick on your back. You’ll spend about an hour being observed in the recovery room. Then you can go home.

4. Does the IDET procedure hurt? Will I be anesthetized?

A local anesthetic and mild sedation are used to reduce discomfort during the procedure, but you will be awake and alert so you can talk to your doctor. You will probably feel your usual level of back pain while the disc is being treated. Your doctor will monitor your comfort closely. It is normal for a person’s back pain to be a little bit worse immediately after the procedure and for up to 1 week thereafter.

5. Will the IDET procedure cure my lower back pain?

IDET cannot make the small tears and fissures of a disc “heal” in the same way that an open cut or broken bone heals. However, the majority of patients receiving the IDET procedure experience a significant reduction in pain and are able to regain mobility and get back to work. And, for a few patients, the IDET procedure may eliminate back pain completely. As with every medical intervention, there are some patients for whom the IDET procedure will not provide satisfactory pain relief. For these patients, surgery may still be an option.

6. How do I know if the IDET procedure is right for me?

Only a doctor can tell if the IDET procedure is right for you:

IDET is usually recommended only after patients have completed 6 or more weeks of nonsurgical therapy without significant relief.
Generally, patients with mild degeneration of 1 or 2 discs, small herniations, or internal disc tears are considered the most promising candidates.
IDET is not recommended for patients with severe disc degeneration, severe reduction in disc height (>50%), spinal stenosis, neurological symptoms, or large disc herniations.
Talk to your doctor. If he or she is not familiar with the IDET procedure and patient screening process, ask to be referred to a doctor trained in the IDET procedure.

7. How long does the IDET procedure take?

The procedure takes about an hour. If more than one disc is treated, it may take longer.

8. How soon can I go home after the procedure?

The procedure is usually performed on an outpatient basis and does not require general anesthesia. After an hour of observation in the recovery room, if there are no problems and you feel okay, you can go home. You shouldn’t drive for several days after the procedure, so someone will need to drive you to and from the procedure.

9. How soon can I go back to work after the IDET procedure?

How quickly you return to work will depend on your condition and the nature of your job. Some people are able to return to low physical stress jobs within a few days or week. Most are able to return to office work within 2 weeks. Your doctor will tell you when you may return to work.

During the first 6 weeks after the procedure, limits should be placed on the heaviness of objects you lift and on time spent sitting, standing, and driving. In addition, there should be no bending or twisting of the lower back. [Saal 2002A]

The following table summarizes general guidelines for activity restriction:

Activity Restriction Guidelines
Rest:	1-3 days after the procedure and as needed thereafter (mostly reclining, with limited upright sitting).
Corset:	May be recommended in the first 6 weeks to limit movement.
Return to work:	If your job is mostly sitting at a desk, you may be able to return to work as soon 1-5 days after IDET, but more likely, it will be around the 2nd week. If your job involves heavy work, you may be off for 3 or more months.
Walking:	Okay to start walking (short distances) as soon as possible.
Driving:	You can return to driving within a few days after the procedure.
Sitting:	Limit upright sitting to 30-45 minutes for the first 2 weeks, and increase gradually. Avoid heavy work.

10. What results can I expect from the IDET procedure?

The treated disc or discs will require time to heal. It will also take time for a “disc stiffening effect” to set in.

Persistent and sometimes increased lower back pain is expected in the first week after the IDET procedure.
By the end of the second week, pain should have returned to at least the same level it was before the IDET procedure.
Many studies have shown that 50%-60% of patients have good or excellent relief of pain following the IDET procedure.
Improved ability to move around and take care of the usual activities of daily life and reduced need for pain medications are among the benefits of the IDET procedure.

Your chances for a good outcome will be greatly improved by following your doctor’s recommendations for pre- and postprocedural care.

11. What are the risks associated with the IDET procedure?

IDET is a minimally invasive procedure with few potentially serious risks and an impressive record of safe use in actual practice. Potential risks related to the IDET procedure include the following:

Pain: Persistent and sometimes increased low back pain is expected in the 1st week after the IDET procedure.
Nerve injury: Any time a needle is inserted into the spine, there is some risk of nerve injury. However, the use of real-time x-ray visualization and keeping you awake and responsive under partial anesthesia may help reduce this risk.
Probe breakage: Excessive manipulation of the flexible probe may cause it to kink and break off in the disc. However, the probe material is inert, so in most cases the broken tip may be left in the disc with no risk to you.

12. What are the advantages of the IDET procedure over spinal fusion surgery?

The IDET procedure is a minimally invasive procedure. Unlike spinal fusion surgery:

The IDET procedure has fewer risks.
The IDET procedure has a lower cost.
The IDET procedure has a shorter recovery time.
The IDET procedure does not restrict the flexibility and mobility of the lower back.

If you have the procedure and it doesn’t work, you may still be able to have spinal fusion surgery at a later time.

13. How can I find an experienced practitioner of the IDET procedure?

Thousands of doctors in the United States have been trained in the IDET procedure. To locate a physician in your area, see Find a physician.

14. Is the IDET procedure an experimental procedure? Is it covered by insurance?

IDET is not an experimental procedure. Since 1998 it has been performed in well over 75,000 patients in the United States alone. It is also widely practiced in other countries around the world. Many insurance companies provide reimbursement for the IDET procedure. You should check with your insurance provider to see whether the procedure is covered under your healthcare plan.