IDET

What is SpineCATH IDET Therapy?

With age, or due to injury, cracks or fissures may develop in the wall of the intervertebral disc. Filled with small nerve endings and blood vessels, these fissures are a chronic source of pain in many patients. Additionally, the inner disc tissue (nucleus) herniated will frequently bulge disc (herniated) into these fissures in the outer region of the disc, likewise stimulation pain sensors within the disc. SpineCATH IDET therapy is a minimally invasive treatment in which the physician applies controlled levels of thermal energy (heat) to a broad section of the affected disc wall. This heat contracts and thickens the collagen of the disc wall, and raises the temperature of the nerve endings. Therapy may result in contraction or closure of the disc wall fissures, a reduction in the bulge of the inner disc material, and desensitization of the pain sensors within the disc.

Who may benefit from SpineCATH IDET therapy?

SpineCATH IDET therapy acts exclusively upon the tissues of the disc itself, and should not be expected to relieve symptoms from other spinal structures, such as nerve roots or spinal joints. It is therefore very important for your physician to diagnose that the disc is the primary source of your back pain. In addition to a clinical examination, your physician may use Magnetic Resonance Imaging (MRI) or injections of dye into the disc (discography) to confirm the diagnosis. Once satisfied that one or more discs are the primary source of your lower back pain, your physician may recommend SpineCATH IDET therapy.

What happens during the procedure?

SpineCATH IDET therapy is usually performed on an outpatient basis. Local anesthesia and mild sedation may be used to reduce discomfort during the procedure. You will be awake and alert so that you can provide important feedback to the physician. With the guidance of x-ray images, your physician will advance a needle into the disc. The SpineCATH catheter will be passed through the needle and into the disc. Once it is in the appropriate position, the temperature of the heating section of the catheter will be gradually increased, raising the disc wall temperature. During the heating protocol, your physician will monitor your condition and comfort level closely. You will most probably feel a reproduction of your usual lower back pain. This is a strong indication that the heat is being applied to the appropriate areas. Once the therapy is completed, the catheter and needle are removed.

What to expect the day of surgery:

Upon arrival to our Center the receptionist will register you and copy your insurance card. You will then be escorted to a room where our staff will complete a pre-assessment of your past and current health history. You will then speak to our staff anesthesiologist who will discuss the appropriate anesthesia protocol which will best suit your needs.

After the pre-assessment, you will be escorted to the same day surgery unit where baseline vital signs will be recorded and an intravenous line will be started. After surgery is completed, your stay in recovery will be approximately 45 minutes. You will then be transported back to the pre-operative area, or discharged home. It is necessary to have a responsible adult to accompany you home.

You will be given a post-operative appointment card prior to your discharge. If you wear acrylic nails, any 2 nails on the left hand must be removed before arriving at the Surgery Center.

What happens after the procedure?

The discomfort generated when the disc is heated may take several days to subside, and your physician may prescribe medication. During the disc healing process, up to 12 to 16 weeks following the procedure, it is very important to treat your discs with care. You physician will provide you with active and physical rehabilitation guidelines. Studies have shown that it is during this time that most patients begin to experience relief from their lower back pain symptoms, a reduction or elimination of any medication use, and an increase in their functional abilities. Improvements may continue up to six months following the procedure.

Post-procedure instructions

Intradiscal Electrothermal Therapy (Idet) Guidelines

I. Pre-operative Preparation

	A.	One week before the procedure
		· Stop all NSAID’s, aspirin and aspirin containing compounds · CONTINUE heart, blood pressure or diabetes medications, or other medications prescribed by a physician

	B.	Be sure to tell your physician if:
		· You are taking blood thinners or have a history of bleeding disorder · You are allergic to iodine (for example, shellfish or IVP dye) · You have an infection in any part of your body

Rest well the night before the procedure. You should not eat the day of your procedure although you may drink small amounts of clear liquids. You should arrange to have someone drive you to and from the facility. Due to the sedative medications given during the procedure, you should not drive until the day after your treatment.

II. During the Procedure

An IV will be placed in your arm and you will be given a light sedative. 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.

Your physician will 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. 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 typical disc-related symptoms. Your physician will ask you questions during the procedure to ensure that any pain you feel is well controlled.

Once the heating protocol is completed, the catheter is removed. Your physician may injection an x-ray dye into the disc for diagnostic purposes. 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.

III. Course of Recovery

Many patients experience an increase in their typical pain (back, back and leg) after the procedure. The post-operative pain gradually subsides over the first seven days. Most patients return to at least the pre-procedure pain level between the first and second weeks after the procedure.

The heat treated disc requires time to heal. Symptom improvement is typically gradual, and some patients do notice symptom relief for as long as 5 months following the procedure. Remain patient and be careful.

IV. Immediate Post-operative Management

In the first three 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. Non-steroidal anti-inflammatories may be taken.

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

You should not exert yourself during this time, even if you experience a marked reduction in your usual pre-procedure pain, because exertion may negatively affect the overall outcome. No housework, lifting or bending should be done. Short walks (15 to 20 minutes) are okay, but generally the first few 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 one to five days after the procedure.

Your condition will be continually assessed during scheduled follow-up visits with your physician.

V. Mid-Term Post-operative Management

For the first month following the procedure, your disc continues to heal. You may begin to feel a reduction in pain. However, pain reduction may occur over three to four months.

During the first month, you must treat your back carefully. Restrict bending, twisting or heavy lifting. No sports activities including running, biking, golfing, tennis, skiing, etc are allowed.

Limit your sitting time to tolerance levels and limit long car rides and plane flights to only what is absolutely necessary. You do not have to abstain from sexual activity, but be careful not to exert your back.

Anti-inflammatory medications and/or pain medication may be prescribed if needed to control discomfort associated with your normal back pain. Icing one to two times per day is advisable to reduce any low back discomfort.

VI. Rehabilitation Exercises

Your physician will guide you regarding rehabilitation exercises after your procedure. If you have been performing strenuous 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 rehabilitation exercise program.

VII. Long Term Post-operative Management

In the second, third and fourth months post-operatively you should continue to maintain good body mechanics. Do not bend or lift improperly. Your physician and physical therapist will help you resume an exercise program to improve your strength and flexibility. If you plant to return to athletic pursuits, special advanced training will probably help you achieve this goal.

Your physician may allow you to resume sporting activity four to five months after the procedure. Advice regarding your return to activities will be individualized to your case by your physician.

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