About five years ago, I had a spinal fusion at L45. Now I’m having disc problems at the L34 level. I’ve heard there’s a new heat treatment I could try instead of surgery. How do I find out more about this?

You may be thinking of intradiscal electrothermal (IDET) therapy. This is a minimally invasive procedure that has had good success so far. The surgeon inserts a catheter (long thin tube) into the disc space. A heating coil is passed down through the catheter into the disc space. The coil is used to raise the temperature.

Studies are still in the preliminary phases. This treatment has not been compared directly to spinal fusion. The cost of IDET is certainly much less than fusion. The risk of complications or problems after the procedure is minimal compared to fusion.

Results of research so far suggest that patients should be selected for IDET very carefully. The success of the IDET treatment seems to depend on proper patient selection. Each surgeon will have his or her own criteria for candidates. These may include:

  • persistent low back pain for more than six months
  • pain is coming from the disc, not the joint, ligaments, or other soft tissue structures
  • patient has taken antiinflammatory drugs and/or pain relievers without success
  • patient has had no improvement with other conservative care such as
    chiropractic, physical therapy, acupuncture, physical activity and exercise

    Many surgeons exclude any patients who have had a prior spine surgery, structural deformities, or spinal stenosis. Since you have had a one-level fusion already, you may not be eligible for IDET. Disc height has to be 60 per cent of normal. A positive discography (test for disc as the cause of pain) may be required.

    Make an appointment with the orthopedic doctor or neurosurgeon who did your previous spinal fusion. Ask about your various options for treatment. Try the conservative approach before thinking about IDET or another fusion.