Originally Posted by Doc.Sust
IDET, or thermal anuloplasty is the introduction of a special wire placed through a needle that enters into the disk. The purpose of that is to alter the protein that makes up the disk fiber; in so doing, it thickens, shrinks, when it's heated. This is pretty much the same application that the sports doctors use when they shrink and thicken the capsules of the shoulder for people who dislocate this joint. It also destroys the tiny nerve fibers that take pain messages from the outside of the pulpy substance of the disk, which is called anulus fibrosis. Treatment is minimally invasive. It's done with the patient awake with intravenous sedation, and this is the safety part of the procedure, so that if something bad was happening, the temperature probe can be turned off to minimize harm. It's done under fluoroscopy and the patient is sent home within 30 to 40 minutes with a band aid on his / her back. There are specific instructions as far as physical activity that must be adhered to. The effects of IDET can be immediate, intermediate, or longer term in coming. The patient may notice complete or substantial loss of pain that was present before the procedure. Typically it takes about six weeks after the procedure for improvement to begin. The improvement can continue for as long as one year. In other words, we've seen patients in whom we felt that the procedure had not been successful at four and six months come back at a year, and are doing really very well.
Let's talk percentages. The percentage number of patients reporting benefit from this procedure in a highly selected group, and the technical problems associated with it, but assume the doctor knows what he's doing from the standpoint of diagnosis and treatment, that percentage is 70 to 72 percent. It is not any more than that at this time. Some people might think that's not good. The fact of the matter is I believe that it's very good because, as this caller indicated, the only other option left is to stay with the pain you have, or have a spinal fusion. That is a big undertaking.
The last part of her question was, what happens in the future. The answer is, I don't know. Nor do the people who have devised this procedure. The reason I say that is that the longest time at this point, and we have been responsible for some of the research for this product, has not exceeded two to three years follow up. In that time, we have not, and I want to emphasize NOT seen an adverse effect. That doesn't mean that can't come at five, seven or ten years. It comes down to treatment options. If you take the disk out to do an anterior fusion, then the disk is gone forever. If you simply try to alleviate the pain with the IDET procedure, then other treatment options may come available as we increase the science of treating these disorders. One of the options is that we're doing at the Texas Instutute, one of five in the US, we implanted artificial disks. The purpose was to not do the spinal fusion. Once you fuse a segment, that segment becomes stiff and the segment above or below becomes stressed and will, with time, deteriorate. The artificial disk, like the knee or hip, allows that joint to continue to move and therefore spare the other segments. Personally, I would not recommend a spinal fusion in a young person if there are other treatment options. Only if the patient does not fit protocol for IDET procedure would I suggest that a fusion be considered.
Taken from Dr. Rosenbaum, MD
now has she tried this procedure? was it an option?
