Spinal Disc Therapies The intervertebral disc is often a primary source for chronic pain and has been the focus of much recent research. Scientific advances in the past five years have led to an improved understanding of disc pain and to new and improved methods for the diagnosis and treatment of pain caused by spinal discs. At Lansdale Pain Management , we use the most advanced techniques available to treat disc-related pain. These techniques include diagnostic discography, therapeutic intradiscal injection, and a new treatment called Intradiscal Electrothermal Therapy (IDET). Diagnostic Discography Before rational treatment for neck and back pain can begin, a precise diagnosis must be made. Imaging studies such as MRI and CT scans can reveal disc anatomy but cannot determine whether discs are painful. Newly developed fluoroscopic techniques allow the pain specialist physician to place fine needles into the center of discs suspected of being pain generators. These discs can then be injected with x-ray contrast to visualize disc anatomy in real time and to determine pain response to pressure, a process known as discography. A normal disc is not painful when pressurized, whereas a pain-generating disc will cause a reproduction of typical pain when pressurized. Therapeutic Intradiscal Injections Through discography, a relatively precise diagnosis can often be made and specific treatment targeted to the problem discs. Therapeutic intradiscal steroid injections may be performed simultaneously with diagnostic discography. Alternatively, the discography results can be used to plan further intradiscal therapy or spine surgery. Intradiscal Electrothermal Therapy (IDET) Recent research has determined that spinal discs may become painful as the disc annulus develops cracks and fissures from either degeneration or injury. These fissures in the disc annulus may become infiltrated with abnormal, pain-sensing nerve fibers and may allow inflammatory chemicals to leak into the spinal canal. Previously no treatment existed for chronically painful, degenerative discs short of major lumbar fusion surgery with removal of the painful discs and implantation of spinal hardware or bone. Researchers at Stanford University have developed Intradiscal Electrothermal Therapy (IDET) as an alternative to lumbar fusion surgery. IDET is a method for repairing deteriorated lumbar discs without surgery. The IDET procedure involves placing a wire into the disc annulus and heating the internal annulus to high temperatures for 14 to 17 minutes. This heating process contracts the collagen material within the annulus thus making the annulus more firm and secure. Simultaneously, the heat lesion destroys the abnormal pain-sensing nerve fibers within the disc thereby rendering the disc non-painful. IDET is indicated for patients with chronic, disabling low back pain caused by painful, degenerating lumbar discs when pain is unresponsive to more conservative interventions. IDET is an outpatient procedure performed in the pain clinic and typically takes less than one hour. The patient may miss work for several days but then may return to sedentary activity. After six weeks, more strenuous physical activity with a formal spinal-strengthening program may begin. Home | Procedures | Comments