- Anatomy of The Spine
- Back Pain in Children
- Caring for your Spine
- Emerging Spinecare Trends
- Evaluation of Spinal Disorders
- Exercise and The Spine
- Intervention - Spinal Disorders
- Intervertebral Disc
- Non Surgical Options
- Nutrition and Spinecare
- Options for Spine Treatments
- Pregnancy and Back Pain
- Prevalence of Spine Disorders
- Sleep and the Spine
- Spinecare Introduction
- Spinehealth and Disease
- Surgical Interventions
- Treatment with Medications
- Understanding Back Pain
YOU are here : Home > Spinecare Topics > Intervention - Spinal Disorders > Minimally Invasive Intervention for Spine Pain
Spinecare Topics
Intervention - Spinal Disorders
Minimally Invasive Intervention for Spine Pain
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Minimally Invasive Intervention for Spine Pain
Intradiscal Electrothermal Annuloplasty
Background: Back pain continues to be the one of the most common complaints resulting in a trip to the doctor’s office. Most back pain improves spontaneously with a course of conservative care and a period of 6-8 weeks. It has been confirmed that the intervertebral disc can be a significant source of acute as well as chronic back pain. Disc pain can arise as a result of small tears within the disc, and/or disc herniation. In the past individuals who have confirmed primary discogenic pain, which did not respond to conservative care ended up undergoing surgical discectomy with fusion. This approach has yielded mixed results.
Indications for Procedure: Intradiscal Electrothermal Annuloplasty (IDET) should be considered for the care of chronic and confirmed discogenic pain syndromes, which are unresponsive to conservative care. The candidate should have had low back pain of at least six months’ duration, should have limited physical capacity, and back pain greater than leg pain without classic nerve root symptoms. It should be considered in cases where there is neuroimaging confirmation of no extruded disc fragments and no evidence of significant nerve root compression or impingement. It should consider when a provocative discogram has been performed confirming the presence of concordant pain reproduction with low-pressure injection at one or more intervertebral disc levels. Prior to performing IDET an advanced imaging procedure of the intervertebral disc levels should be performed to determine whether there are any significant annular tears and to exclude the presence of significant disc herniation.
Procedure: The IDET procedure is generally performed in a fluoroscopy suite. The patient is usually placed on intravenous conscious sedation. The sedation level should be one that allows the patient to be comfortable and sleepy, but should allow for relatively easy arousal so that the patient can be questioned about radiating pain symptoms during needle placement and heating of the catheter.
The risks associated with the procedure are similar to those requiring any needle puncture plus the additional risks of mechanical tissue compromise during the course of needle and catheter placement. To perform the procedure the patient is placed face down on a movable table in an imaging suite. The procedure is generally done under fluoroscopic image guidance. Local anesthesia is applied. Spinal needles are incrementally advanced under imaging guidance to the disc to be treated. The needle is advanced slowly in an attempt to avoid injuring neighboring nerve structures. Once the needle is placed into the disc catheter, it is then advanced slowly into the needle and subsequently enters the disc.
Under fluoroscopic image guidance, the catheter is advanced carefully and slowly into the center of intervertebral disc. The catheter has an inherent curve in it, which helps the catheter wrap around the inner margin of the annulus. The catheter is placed within the nucleus pulposus or gel-like center of the disc. The position of the catheter is confirmed with use of fluoroscopic X-ray imaging. Catheter navigation is usually not painful although there may be a sense of discomfort. The catheter is advanced to achieve positioning with a heating element. It can be extremely difficult to navigate the catheter in a severely degenerative dehydrated (stiff) disc. Once the catheter and heating element are in place, the technician gradually increases the temperature in an attempt to achieve catheter heating of 90 degree centigrade for 4-6 minutes.
Background: Back pain continues to be the one of the most common complaints resulting in a trip to the doctor’s office. Most back pain improves spontaneously with a course of conservative care and a period of 6-8 weeks. It has been confirmed that the intervertebral disc can be a significant source of acute as well as chronic back pain. Disc pain can arise as a result of small tears within the disc, and/or disc herniation. In the past individuals who have confirmed primary discogenic pain, which did not respond to conservative care ended up undergoing surgical discectomy with fusion. This approach has yielded mixed results.
Indications for Procedure: Intradiscal Electrothermal Annuloplasty (IDET) should be considered for the care of chronic and confirmed discogenic pain syndromes, which are unresponsive to conservative care. The candidate should have had low back pain of at least six months’ duration, should have limited physical capacity, and back pain greater than leg pain without classic nerve root symptoms. It should be considered in cases where there is neuroimaging confirmation of no extruded disc fragments and no evidence of significant nerve root compression or impingement. It should consider when a provocative discogram has been performed confirming the presence of concordant pain reproduction with low-pressure injection at one or more intervertebral disc levels. Prior to performing IDET an advanced imaging procedure of the intervertebral disc levels should be performed to determine whether there are any significant annular tears and to exclude the presence of significant disc herniation.
Procedure: The IDET procedure is generally performed in a fluoroscopy suite. The patient is usually placed on intravenous conscious sedation. The sedation level should be one that allows the patient to be comfortable and sleepy, but should allow for relatively easy arousal so that the patient can be questioned about radiating pain symptoms during needle placement and heating of the catheter.
The risks associated with the procedure are similar to those requiring any needle puncture plus the additional risks of mechanical tissue compromise during the course of needle and catheter placement. To perform the procedure the patient is placed face down on a movable table in an imaging suite. The procedure is generally done under fluoroscopic image guidance. Local anesthesia is applied. Spinal needles are incrementally advanced under imaging guidance to the disc to be treated. The needle is advanced slowly in an attempt to avoid injuring neighboring nerve structures. Once the needle is placed into the disc catheter, it is then advanced slowly into the needle and subsequently enters the disc.
Under fluoroscopic image guidance, the catheter is advanced carefully and slowly into the center of intervertebral disc. The catheter has an inherent curve in it, which helps the catheter wrap around the inner margin of the annulus. The catheter is placed within the nucleus pulposus or gel-like center of the disc. The position of the catheter is confirmed with use of fluoroscopic X-ray imaging. Catheter navigation is usually not painful although there may be a sense of discomfort. The catheter is advanced to achieve positioning with a heating element. It can be extremely difficult to navigate the catheter in a severely degenerative dehydrated (stiff) disc. Once the catheter and heating element are in place, the technician gradually increases the temperature in an attempt to achieve catheter heating of 90 degree centigrade for 4-6 minutes.
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
