Description of Treatment/Procedure

Low back pain, a common occurrence in adults, is caused by a variety of conditions. Approximately one million Americans suffer from chronic low back pain caused by damage to spinal disks. Treatments for chronic, discogenic lower back pain include physical therapy and steroid injections followed by more aggressive strategies such as surgery, discectomy and spinal fusion. Intradiscal Electrothermal Therapy (IDET) is a new, minimally invasive treatment for discogenic low back pain. In IDET, a catheter containing a copper wire-heating coil is threaded into the nucleus pulposus of the degenerative disk. The coil is heated to approximately 90 degrees Celsius for about fifteen minutes in a targeted area on the inner side of the annular wall. The mechanism of action remains controversial. However, it has been theorized that these controlled levels of thermal energy (heat) may stabilize fissures by potentially strengthening structural collagen, reducing the volume of the bulging nucleus pulposus, and destroying painful nerve fibers and blood vessels inside the disk. Short-term studies have not indicated many adverse effects of IDET, but information on long-term effects is limited.

Committee Summary

With regard to Intradiscal Electrothermal Therapy (IDET) for Low Back Pain the ICSI Technology Assessment Committee finds:

1. There is no convincing evidence that shows the short or long-term clinical efficacy of this procedure. Only subjective outcomes from case series and one non-randomized trial have been reported. Blinded, randomized studies comparing the procedure to a placebo treatment or alternative treatments such as spinal fusion have not been done and are needed to develop any conclusion about efficacy of the procedure (Conclusion Grade III).
   
2. The procedure is acceptably safe when performed by a physician trained in IDET, experienced in the diagnosis and management of low back pain, and experienced in the placement of needles into the intravertebral disk. Short-term studies have indicated few adverse effects of IDET, but information on long-term effects is limited.
   
3. The long-term effects of thermal coagulation of the disk are unknown at this time.