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    Old 04-28-2004, 12:48 PM   #1
    Amy R.
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    Question IDET not for tears??

    Hi! I'm getting the disco in late May to see if my L3-4 and L4-5 tears (shown as HIZ on MRI) are painful or not. We'll see! My pm doc then said that IDET is done just to deaden some disc nerves for a while so that aggressive PT can take place - then the nerves regenerate (like rf, but on a disc). I asked about IDET's role in tears - (for which I thought it was created) - and he said, no, we used to think IDET sealed tears, but not anymore. Is this true?? IDET doesn't apply to tears??? And if that's the case, does that mean nothing does??

     
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    Old 04-28-2004, 02:22 PM   #2
    LS56
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    Re: IDET not for tears??

    I was never told that IDET would seal tears, if you're talking about annular tears; in fact, I've specifically read that there is no way currently known to fix those once they occur. I'm potentially facing an IDET, and the doctor told me that the high heat might seal the bulging/leaking part of the disc (at least temporarily) and provide pain relief by "toughening the fibers" and essentially destroying the small nerve endings. In my research, I've not found any procedure that will repair or "sew up" a disc once it has ruptured.

    Have you found any other information about the IDET procedure? It's so new that I'm having trouble finding information sources. My doctor gave me a 50% success rate, at least for the problems I'm having, but if it can avoid surgery then it's worth it. I had a "traditional neurosurgeon", though, turn up his nose and say "well, you should research this procedure and your options so you understand its implications and the limitations it will impose on your future treatment very carefully". Which could be sour grapes, since he said "we, of course, don't do this procedure ourselves". I'd be very interested in anything that you have found out.

     
    Old 04-28-2004, 04:10 PM   #3
    Amy R.
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    Re: IDET not for tears??

    Yes, I was talking about those horrible annular tears.

    That's strange he said that - the one good thing I've found about it is that it doesn't affect future surgeries - that it does not impose on future treatments. For example, you could still have a fusion or artificial replacement, just like everyone else. If he tells you to research it, and gives you no research to read....what in the world??

    I had a younger pain mg doc who was very encouraged re. idet and very knowledgeable, and now he's making his 'rounds' so I'm back w/ the older doc who never explains anything. All he said is he does a 'different kind of idet' (???) and that it is a short-term coverup. Of course, he didn't explain, and I haven't found much reliable data, either.

    The Emory Spine Center told me only 2 reliable tests have been done in the RECENT past, one having good results and one not. I will find my papers and remember exactly what they said.

    Why just 50%, did they say? Do you have low disc height??

    What did your disco say? I have mine in late may. I heard it hurts worse than the idet. I am so scared!

     
    Old 04-29-2004, 08:23 AM   #4
    GracieGirl
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    Re: IDET not for tears??

    My pm dr actually trains other drs to perform the IDET. He said the success rate is all in how you choose your patients. My ortho also told me not to do it because he said it would not work. I think he said that because he doesn't do it and would not profit. From what I understand it is minimally invasive and still leaves other options open should it not work. This is not true with other surgeries. Hey, even if it buys me 5 years I would do it. I too, am looking toward a discogram to see if I qualify. Good luck Amy R. I guess the rf lesioning was not your magic bullet. I am sorry you had to go through that. My dr decided not to do that on me yet and is looking at the IDET now, too. Keep us posted.
    Graciegirl

     
    Old 04-29-2004, 03:56 PM   #5
    kvn60640
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    Re: IDET not for tears??

    I considered having the IDET at one point but I decided not to be a guinea pig. This is supposed to actually change the chemical structure of the nucleous pulpous and they dont have any idea what the long term ramifications are. Docs who do this profit tremendously from it so they kinda push it. Its usually done by anesthiseologists and not neuros or orthos who have a lot more education and knowledge of the spine than just a pain doc. I'd be very leary of this procedure if I were you guys. Just an opinion.
    Kevin

     
    Old 04-29-2004, 06:25 PM   #6
    kksgirls
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    Re: IDET not for tears??

    Amy,

    Just a note re: IDET. They heat the disc anywhere from 70-90 degree Celsius. The recovery time is long. Read Successtory's posts about this procedure before you agree to it. Just have all the information - just like you're doing now....arm yourself w/ knowledge ~ then make the best informed decision for you. Get 2nd and 3rd opinions. You may end up w/ 3 different opinions ~ but, if that's what it takes to cement whatever decision You've made ~ then so be it. Just be sure, that's all I'm saying.

    Good luck! When's the discogram scheduled for? Want to be sending positive thoughts your way!

    kk

     
    Old 04-30-2004, 06:32 AM   #7
    Amy R.
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    Re: IDET not for tears??

    late may...oh, that heating sounds so scary. I'm so sick of having to be conscious for every single test and procedure!!

    I know the recovery is long, and I don't know how I'd get through it . I'd rather spend 3 months in the hospital than at home, if that makes any sense. I'd like to just get it, rest in the hospital, and come out better....rather than be at my house, looking outside at people running, waking dogs, and playing w/ kids

     
    Old 04-30-2004, 07:14 AM   #8
    kksgirls
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    Re: IDET not for tears??

    Amy,

    I know what you mean about wanting to stay in the hospital for recovery...but, insurance companies have effectively ended real care, it seems. Most procedures are same day - and, buh-bye~ it's ridiculous. I think that, if they could get away w/ it, they'd have women have babies, clean the kid up, and send them on their way!

    With any surgery, you just have t/b sure to have the help you need to recover properly. No sense in doing it if you can't do it right. And eventhen, there's no guarantee that it'll work. Like me. I did Everything possible to make my procedure a success. My doctor is good. It's a good hospital. I got a back brace. I made sure I had help lifting the girls. I followed instructions. Doesn't matter, it wasn't destined to work. But, I did the best I could....I know that....and that's priceless. If I hadn't done everything w/in my power, I would be an emotional mess. At least this way, I tried.

    I hope you get the answers you're seeking w/ the discogram. If it's positive, at least you'll know where the pain's coming from. In my case, that was such a relief. Wierd, being 'happy' that I have a torn disc! ha

    Karen

     
    Old 04-30-2004, 02:10 PM   #9
    LS56
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    Re: IDET not for tears??

    I have my disco next Friday, and terrified is not the word for it. I have to have FOUR discs injected, and I had trouble getting through one epidural steroid injection, which is not anywhere near as invasive nor as painful. I have actually had some sleepless nights already accompanied by some pretty ridiculous weeping over the thought of it, so I can't imagine what the next 6 days (and nights) are going to bring until the fateful day is here. It's dumb - I'm starting to puddle up and weep just writing this and thinking about the fact that a week from today I have to walk through that hospital door to be tortured. OK, stop this!

    I think the doc is only giving me a 50% chance of success because I have so many bad discs, we don't know which ones have which problems and are causing which problems, and I do have quite a bit of shrinkage in at least some of the inter-vertebral spaces for the bad discs. Too, my primary problem is not so much pain as it is nerve impingement, and I've read that IDET is specifically not indicated for that. So I'm totally confused. I like the minimal approach, since I can always have something more invasive done in the future, but what if it does nothing at all for me? I'm frankly not as worried about changing the chemical structure of the nucleus, since I don't think my discs are long for this world anyway. I'm trying to find something that will keep me going to 3-5 years until artificial discs are approved and used long enough to be a viable option. I do have an appointment with a "traditional neurosurgeon" in two weeks, so I'm going to compare his surgical recommendations with the physiatrist that is recommending the IDET (along with a micro-discectomy on one of the other problem children).

    Let me know what info you find out about IDET studies. I've only found one.

     
    Old 04-30-2004, 02:24 PM   #10
    khoff
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    Re: IDET not for tears??

    LS56 -

    Long-term Results of Intradiscal Electrothermal Therapy Disappointing


    Laurie Barclay, MD


    April 13, 2004 At one-year follow-up, about half the patients treated with intradiscal electrothermal therapy (IDET) for discogenic chronic low back pain were dissatisfied, according to the results of a retrospective study published in the April 1 issue of Spine.

    "IDET was introduced as a procedure for discogenic pain," write Timothy T. Davis, MD, from the Spine Institute in Santa Monica, California, and colleagues. "Several studies reported improvement in greater than 70% of patients."

    Approximately one year after IDET, 60 patients who had been referred by 17 physicians were contacted for an independent evaluation, including self-administered questionnaire and telephone interview, regarding functional status, symptoms, and subsequent treatments. All patients initially had a positive discogram. Average age was 40 years (range, 25-64 years); 66% were men and 34% were women.

    Of 44 patients who agreed to take part in the study, six patients had a lumbar surgery within one year, and their outcomes were excluded from descriptive analysis. Back pain persisted in 97% of patients.

    Compared with their status before IDET, 11 patients (29%) had more pain after IDET, 15 patients (39%) had less pain, and 11 patients (29%) had no change in pain. Medication use increased after IDET in 11 patients (29%), stayed the same in 10 patients (26%), decreased in 12 patients (32%), and was no longer needed in five patients (13%).

    Half of the patients (19; 50%) were dissatisfied with IDET, 14 patients (37%) were satisfied, and five (13%) were undecided. Twenty patients (53%) said they would have the procedure again, 12 patients (31%) would not, and six patients (16%) were unsure.

    After surgery, most patients wore a brace more than six hours per day for one to 15 months. Before IDET, 16 patients (42%) were employed full-time compared with 11 patients (29%) after IDET.

    Study limitations include not being able to validate pre-IDET responses, lack of a standardized preoperative measure of pain, retrospective collection of pre-IDET data, and difficulty in ascertaining the placebo effect of an invasive procedure.

    "At one year post-IDET, half of patients were dissatisfied with their outcome," the authors write. "The percentage of patients on disability remained constant. The estimated proportion of patients undergoing fusion was predicted to be 15% at one year and 30% at two years."

    IDET is approved by the U.S. Food and Drug Administration for this indication. This study received no external funding, and the authors report no financial conflicts of interest.

    Spine. 2004;29:752-756

    Reviewed by Gary D. Vogin, MD


    - Ken

     
    Old 05-01-2004, 08:31 PM   #11
    standingman
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    Re: IDET not for tears??

    Ken--Thanks for your post which should be valuable, if not inspiring, for many. How are _you_ doing?

    Standingman

     
    Old 05-02-2004, 05:58 AM   #12
    khoff
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    Re: IDET not for tears??

    Standingman -

    Hi! I am now at the end of all my diagnostic tests, procedures, etc...
    Even went to see a few top notch surgeons. Surgery is not recommended by both. IDET was a consideration by docs, but I said no way. ESI's no longer help.
    My plan is to continue physical therapy forever and try to get more strengthing exercises in since all that helps. I will probably be on some type pain medication for maybe a long time and I have accepted this. I am now trying to find the right one. I have tried every anti-inflammatory, muscle relaxant, anti-eleptic, and a few minor opiods all with no luck. The percocet and oxycontin helps, but side effects worry me. So I will try some others which I think may help. Acceptance, not resignation.
    I also take zoloft for the depression and go to CBT which helps. And I am a member of a chronic pain support group which also helps. I am trying now to re-learn my thinking and adjust to a new style of life and learn what I can and can't do.
    Not the way I had planned my life, but I will adapt. My spiritual life (buddhism) helps alot with seeing the real goals.

    How are you doing? What is your prognosis ?

    - Ken

     
    Old 05-02-2004, 06:49 AM   #13
    kksgirls
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    Re: IDET not for tears??

    Ken ~

    I agree w/ SM ~ your post w/b very educational for anyone considering the IDET.

    I am now doing more research on the SED. (Dr Yeung) I hear that he includes the RF along w/ the SED to possibly 'seal the tear' of the disc! I am interested to find out if anybody else is using this approach, or if he has the corner on the 'market' ~ so to speak.

    Did you send your films to him? If so, which films?

    kk

     
    Old 05-02-2004, 07:05 AM   #14
    ktshobe
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    Re: IDET not for tears??

    Hi there. I don't know if this helps, but I had IDET on 23 Jan this year, and I have finally given in to the fact that it did not work. I have tried everything in the book - except for surgery. According to the docs, IDET was the last thing they could do. Yes, I am in PT, but no luck yet. I was excited about the possibility of ADR, but read that spondylothesis is a disqualifing condition.

    I would still recommend doing IDET, as the consequences of doing it are minimal (unless you get a bad doc). I was in pain for quite a while afterwards, but now am back to "normal".

    I also hate the fact that we are conscious during all these procedures! The only good thing is that we can't see the things they stick in the back (at least I couldn't).

    good luck.
    kt

     
    Old 05-02-2004, 09:43 AM   #15
    standingman
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    Re: IDET not for tears??

    Ken--Thanks for the update. What you're describing deserves a thread in itself--maybe several. Of course, there have been such, here and elsewhere, as you describe being involved in.

    My situation is somewhat similar but a lot less pain--or, pain is more all/nothing for me, and when it's "all" there is the real possibility of adding to already irreparable nerve damage. So, as I've said to friends, it's not like having the sword of Damocles over my head......it's like having it under my.......seat! Thus my world remains mostly a standing one.

    As for you, no surgeon (I've seen four very experienced ones) gives me good odds of improvement versus risk of worsening, re-operations, etc.. General recommendation is to keep on keeping on. Luckily for me, I can still walk reasonably well, and I do a lot of it--1-2 hours/day, with hills--which keeps me going more than anything else. Also what I call "PT's greatest hits"--the things I've picked up, after four different PTs, that seem to do more good than harm. Not always easy to tell!

    Anyway, this is a long way fron IDET. On k's post above, the question of the potential harm of IDET (beyond its low success rate) remains an open one as far as I understand it. Like nucleoplasty or any of the other new procedures, I think it should probably be considered "surgery" until proven otherwise--meaning, most if not all of the potential attendant risks, and some of its own.

    Best to all, power to the lumbar jocks!

    Standingman

     
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