Minimally Invasive Treatments for Low Back Pain

A diagnostic strategy properly conducted leads to specific treatment. For the predominant causes of back pain, treatment is available. When no diagnosis can be established, the treatment will be symptomatic and when all medical and conservative treatments have failed, minimally invasive approach including spinal cord stimulation and intrathecal drug delivery systems will be used.

Intra-Discal-Electro-Therapy (IDET)

It is estimated that in a substantial percentage of patients with chronic back pain the lumbar disk is the pain generator. IDET was developed as an alternative for selected patients with chronic discogenic pain who have failed all conservative treatments and to whom the next step offered was arthrod-esis. Intra-discal electrotherapy was developed because this last treatment was not the perfect response to discogenic pain and because no specific treatment was available for internal disc disruption.

The indication for IDET is demonstrated discogenic pain. As explained in the ''provocative discography'' section of this chapter, painful, low pressure, dye injection into the disc followed by CT-scan imaging constitute the selection criteria for intra-discal therapy.

Under local anaesthesia and under fluoroscopy guidance, a 17 gauge needle is placed into the centre of the disc to be treated. A navigable intra-discal catheter with a temperature-controlled thermal resistive coil is then deployed through the needle and navigated intradiscally under continuous two-plane fluoroscopic control. The catheter is navigated as far as possible adjacent to the inner posterior annulus. Once placement is optimal the catheter temperature is gradually raised according to a uniform protocol to 90°C over a period of 13 minutes and maintained at 90°C for 4 minutes. The 90°C catheter temperature creates annular temperatures of 60-65°C. Some authors advocate the use of prophylactic intradiscal antibiotics but no evidence shows it utility (Fig. 4).

Algorithm Treatment For Hydrocephalus
Fig. 4. A-P view of a placement of an Intra-discal elecrotherapy (IDET) catheter
How To Win Your War Against Back Pain

How To Win Your War Against Back Pain

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