Intradiscal Electrothermal Therapy (IDET) for the Treatment of Discogenic Low Back Pain: Patient Selection and Indications for Use

Discogenic low back pain resulting from internal disc disruption can be severely disabling, clinically challenging, and expensive to treat. Previously, when conservativecare had been exhausted, open surgical intervention such as spinal fusion or artificialdisc replacement was the only treatment option for these patients. Intradiscal electrothermal therapy (IDET), a minimally-invasive technique performed in the outpatientsetting, offers an intermediate intervention between conservative care and surgery.Specific selection criteria have been refined that identify patients for treatment withIDET, ensuring maximal clinical benefit and appropriate use of healthcare resources.Indications for use were developed from review of selection criteria from publishedclinical reports and review articles of IDET, and further refined by identifying components with the strongest positive predictive value and by direct physician feedback.Final indications for use consist of clinical and imaging criteria.There are 5 compulsory indications for use: 1) persistent axial low back pain +/- legpain and non-responsive to ≥ 6 weeks of conservative care; 2) history consistent withdiscogenic low back pain without marked lower extremity neurological deficit; 3) oneto 3 desiccated discs with or without small, contained herniated nucleus pulposus byT2-weighted magnetic resonance imaging, with at least 50% remaining disc height;4) concordant pain provocation by low pressure (< 50 psi above opening pressure)discography; and, 5) posterior annular disruption by post-discography computed tomography. Using these patient selection characteristics, approximately 3 of 4 IDETtreated patients should achieve a minimal clinically important improvement in painand disability.Key words: intradiscal electrothermal therapy, IDET, annuloplasty, back pain, discdisruption