A New Advance for Back Pain
AUTHOR: Judson J. Somerville, M.D., 
The Pain Management Clinic of Laredo

Each year millions of Americans suffer from back pain.  As a result, they miss many hours of work and cost industry millions of dollars.  Multiple studies have shown that back pain is second only to the common cold in causing health problems.  Approximately one million suffer from a painful lumbar disc either as a result of a herniated disc or degenerative disc disease.  Improper lifting, automobile accidents and contact sports are some of the activities that can cause injuries to the lumbar disc.  Symptoms of these disorders include low back pain during sitting or bending forward as well as pain shooting down the legs.

Until very recently, the most effective treatment option for a painful lumbar disc that did not respond to medications and other conservative treatments was a surgical procedure called spinal fusion.  This requires a two to three day hospital stay, surgery on the spine, and a six to eight week recovery period.  It is also a very expensive option even for those with private insurance.  Although spinal fusion has helped many patients, there are those who's herniated disc pain was not resolved after surgery.  Additionally, spinal fusion prevents movement in the region of the operated spine and thus puts more pressure on the other discs in the lumbar spine.  This pressure can cause those other discs to wear out more quickly.

Fortunately, the risks of surgery and its accompanying recuperation time have been significantly reduced by the advent of a new technique developed to help treat the herniated lumbar disc and degenerative disc disease.  It's called Intradiscal Electrothermal Annuloplasty (IDET).  Brothers and physicians Jeffrey and Joel Saal developed the IDET at Stanford University.  They had become frustrated by the limited options for patients with herniated discs and it's accompanying pain.  With the help of an MIT engineer they developed the IDET which uses heat to help heal the disc.

To understand how lumbar disc pain develops and how this technique helps to heal that problem let's review the anatomy.  The lumbar spin consists of bones, vertebra and discs.  The discs, located between the vertebra act as shock absorbers for the spine.  As we age, the discs in our back eventually wear out.  The discs in the lower back (lumbar region) tend to wear out faster than the other areas of the spine.  This happens because of increased body weight and years of bending and twisting motions inflicted upon our backs.  The breakdown is called degenerative disc disease.  Cracks form in the discs and new nerves and blood vessels grow into the disc where they don't belong.  The increased pressure in the disc from standing, lifting, sitting or twisting pinches the nerves and causes pain in the low back region.  Additionally, a sudden twisting or lifting motion could cause the disc to herniate, and the symptoms of low back pain can worsen and leg pain can sometimes occur.  This is not only painful, it can cause weakness and/or loss of sensation in the area of the body supplied by that nerve.

With the development of the IDET, lumbar disc pain can be treated with a day procedure at the hospital outpatient center.  To prepare for the procedure, the patient is made comfortable with a small dose of anesthetic.  Using x-ray guidance, the physician locates the painful disc.  He/She places a small catheter inside the disc and heats it to 194F for 17 minutes.  This causes the disc to shrink and destroys the small nerves and blood vessels that have grown into the disc.  Although results vary, and some soreness after the procedure is normal, many patients report they can resume their normal activities within days of undergoing the IDET procedure.  Unlike spinal fusion, the disc is not destroyed by the IDET.  This reduces the risk of other discs wearing out because the range of motion of the spine is not affected.  If for some reason, the IDET was not successful it does not prevent a patient from being able to have surgery.  In a national study conducted by Oratech, the manufacturer of the equipment used to perfom the IDET procedure, the majority of patients who underwent the IDET said they would undergo the procedure again if they had to.

Thanks to Dr. Saal the IDET procedure has now benefited thousands of patients across the country with reduced costs, less lost work time and very good outcomes.  There is currently a program underway to develop the IDET on the cervical and thoracic spine, but for now it is only available for the lumbar region.