Intra-Discal Electrothermal Therapy (IDET)
The members of the Adelaide Spine Clinic were involved in
a prospective randomised trial evaluating the use of Intradiscal
Electrothermal therapy. This was an experimental technique which was
performed percutaneously as a day procedure. A probe was introduced into
the disc using a similar technique to discography, and this probe was then
threaded around the annulus.
The results of this trial study have revealed no
subject in either treatment arm met criteria for successful outcome.
Further analysis showed no significant change in outcome measures in
either group at six months. This study demonstrates no significant benefit
from IDET over placebo. These findings have been presented at
international meetings and the abstract is attached.
Click
here to read abstract
The advert shown below taken from Newsweek (15th March
1999) provides a schematic outline of the technique.
The probe is then heated to 90oC over 10 to
15 minutes and this temperature is maintained for four minutes. It is
proposed that this process results in denervation of the posterior annulus and
alteration in the collagen structure. The net result being a reduction
in discogenic low back pain.
The inventors of the technique report 80% success rates
for selected patients and the procedure has become very popular in the United
States with over 20,000 cases performed to date. However there has not
been a controlled prospective trial to properly assess its
effectiveness.
The inclusion criteria includes patients that have not
undergone previous surgery with single or two level symptomatic disc
degeneration proven by discography. Symptoms need to have been present
for at least six months and an appropriate conservative rehabilitation program
(e.g. Pilates rehabilitation) needs to have been completed.
Where degeneration is advanced and loss of disc height
significant the procedure is technically difficult and the results
questionable. Significant loss of disc height is therefore an exclusion
criteria.
IDET study information
sheet
Disc Replacement
Patients often ask about artificial disc replacement and
a number of devices have been released onto the market.
Professor Fraser is involved in the design and
development of a new artificial disc and has operated on a number of cases
over the last few years. The final design has now been determined and
will be evaluated in an international prospective trial comparing this new
implant with an established technique of spinal fusion. The other
members of the Adelaide Spine Clinic will also be involved in this trial.
Displayed are intra-operative radiographs of the lumbo-sacral
junction after the insertion of a disc replacement. The apparent gap
between two metallic plates is filled with a flexible compound.
