IDET - INTRADISCAL ELECTRO-THERMY
Studies Favorable: Total 19

Level II:  1 Study

1.  Intradiscal Electrothermal Treatment for Chronic Discogenic Low Back Pain: Prospective Outcome Study With a Minimum 2-Year Follow-Up
Saal, Jeffrey A. MD; Saal, Joel S. MD
Spine. 27(9):966-973, May 1, 2002.
Study Design:  Cohort Study
Level II - Favorable
Supports IDET:  A cohort of patients with chronic discogenic low back pain who had failed to improve with
comprehensive nonoperative care demonstrated a statistically significant improvement in pain, physical function,
and quality of life at 2 years after IDET.

Level III:  1 Study

1.  Pain Physician. 2006 Jul;9(3):237-48.
Treatment of intractable discogenic low back pain. A systematic review of spinal fusion and intradiscal
electrothermal therapy (IDET).
Andersson GB, Mekhail NA, Block JE.
Department of Orthopedic Surgery, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, USA. Gunnar_Andersson@rush.edu
Study Design:  Systematic Literature Review
Level III - Favorable  literature review
Supports IDET:  Of all IDET articles reviewed, >25% were case control The IDET procedure appears to offer
sufficiently similar symptom amelioration to spinal fusion without the attendant complications.

Level IV:  14 Studies

1.  Intradiscal Electrothermal Therapy Used to Manage Chronic Discogenic Low Back Pain: New Directions and Interventions
Todd Wetzel, F. MD; McNally, Thomas A. MD; Phillips, Frank M. MD
Spine. 27(22):2621-2626, November 15, 2002.
Literature review of different studies.  All the studies reviewed were  prospective cohorts with historical or non-interventional controls.
Level IV - Favorable
Supports IDET:  The studies published so far suggest that the pain resulting from lumbar disc disease may be
diminished by intradiscal electrothermal annuloplasty. All these studies project a positive therapeutic effect but
with no or historical controls, it reduces to 2 star level.

2.  Intradiscal Therapy: A Review of Current Treatment Modalities
Singh, Kern MD; Ledet, Eric PhD; Carl, Allen MD
Spine. 30(17S):S20-S26, September 1, 2005.
Study Design:  A systematic review of the medical literature regarding current intradiscal therapeutic methods (including IDET), majority were case series
Level IV - Favorable
Supports or Neutral to IDET:  The reviewed literature shows benefit of IDET, but article states that there is paucity of well controlled studies in the literature on efficacy of IDET. 

3.  J La State Med Soc. 2008 Sep-Oct;160(5):280-5
Intradiscal http://www.unboundmedicine.com/medline/ebm/record/19048984/full_citation/Intradiscal_electrothermal
_therapy__IDET_:_a_viable_alternative_to_ surgery_ for_low_back_pain_in_workers'_compensation_patients
electrothermal therapy (IDET): a viable alternative to surgery for low back pain in workers' compensation patients?
Jawahar A, Brandao SM, Howard C, Nunley PD.
Spine Institute of Louisiana, USA.
Study Design:  Case series 53 patients
Level IV - Favorable
Supports IDET:  A mean reduction (p < 0.001) of 63% in the VAS score and 70% in the Oswestry scores was noted after IDET.  Forty-seven percent of the patients returned to some degree of economic productivity and only seven (initial 26) consumed narcotic analgesics.  IDET procedure can be a useful, safe and cost-effective option in the management of carefully selected workers' compensation claimants with chronic low back pain of discogenic etiology.

4.  J Spinal Disord Tech. 2008 Feb;21(1):11-8
Intradiscal electrothermal therapy (IDET) for low back pain in worker's compensation patients: can it provide a potential answer? Long-term results.
Nunley PD, Jawahar A, Brandao SM, Wilkinson KM.
http://www.jspinaldisorders.com/pt/re/jsdt/abstract.00024720-200802000-00003.htm;jsessionid=J9CckmLm3TMphnyfVt02JvQ3yHMBHVcSJQKb82c321QzhGnsb6vS!97158217!181195629
!8091!-1?index=1&database=ppvovft&results=1&count=10&searchid=2&nav=search
Spine Institute of Louisiana, Shreveport, LA 71101, USA.
Study Design: Case series
Level IV - Favorable
Supports IDET:  A mean reduction (P<0.001) of 62.6% in the VAS score and 69.3% in the Oswestry scores was noted after IDET.  IDET procedure can be a useful, safe, and cost-effective option in the management of carefully selected worker's compensation claimants with chronic LBP of discogenic etiology.

5.  Spine. 2000 Oct 15;25(20):2622-7
Intradiscal electrothermal treatment for chronic discogenic low back pain: a prospective outcome study with minimum 1-year follow-up.
Saal JA, Saal JS.
SOAR, Physiatry Medical Group, Menlo Park, CA 94025, USA.
Study Design:  Prospective Case Series
Level IV - Favorable
Supports IDET:  Symptoms improved in 44 (71%) of 62 of the study group on the SF-36 physical function subscale, in 46 (74%) of 62 on the SF-36 Bodily Pain subscale, and in 44 (71%) of 62 on the VAS scores. Twelve (19%) of 62 of the patients did not show improvement on any scale.  A cohort of patients with chronic unremitting low back pain of discogenic origin whose symptoms had failed to improve with aggressive nonoperative care demonstrated a statistically significant and clinically meaningful improvement on the SF-36 and the VAS scores at a minimum follow-up of 1 year after IDET.

6.  Pain Physician. 2002 Oct;5(4):360-4
A prospective outcomes study of patients undergoing intradiscal electrothermy (IDET) for chronic low back pain.
Gerszten PC, Welch WC, McGrath PM, Willis SL
http://www.painphysicianjournal.com/crrent_issue_vw.php?journal=13&code=205&issue=past_issue
Department of Neurological Surgery, University of Pittsburgh School of Medicine, UPMC-Health System, Presbyterian University Hospital, Suite B-400, 200 Lothrop Street, Pittsburgh, PA 15213, USA. gerszten@neuronet.pitt.edu
Study Design:  Prospective case series
Level IV - Favorable
Supports:  IDET was found to be effective in 75% of patients in improving their chronic low back pain. This did not translate into a significant improvement in the SF-36 survey scores. The risks are negligible, and recovery time is minimal. The procedure may be useful in selected patients who would otherwise undergo an interbody fusion procedure.   

7.  J Spinal Disord Tech. 2008 Feb;21(1):55-62.
Intradiscal electrothermal therapy (IDET) provides effective symptom relief in patients with discogenic low back pain.
Maurer P, Block JE, Squillante D.
3B Orthopaedics, Pennsylvania Hospital, University of Pennsylvania Health System, 800 Spruce Street, 8th Floor, Philadelphia, PA, USA.
Study Design:  Prospective Clinical Trial case series
Level IV - Favorable
Supports IDET:  Forty-two patients (75%) were classified as a treatment success by virtue of a >or=2-point improvement in pain severity or a >or=10-point improvement in either the physical functioning or bodily pain domain of the SF-36.  The findings of this study suggest that durable clinical improvements can be realized after IDET in highly selected patients with mild disc degeneration, confirmatory imaging evidence of annular disruption, and concordant pain provocation by low pressure discography.

8.  Neurol Res. 2008 May;30(4):411-6. Epub 2008 Jan 31
Intradiscal electrothermal treatment for chronic discogenic low back pain: a prospective outcome study of 39 patients with the Oswestry disability index at 18 month follow-up.
Ergün R, Sekerci Z, Bulut H, Dolgun H.
http://www.ingentaconnect.com/content/maney/nres/2008/00000030/00000004/art00017
Department of Neurosurgery, Diskapi Hospital, Ankara, Turkey. ruchanergun@hotmail.com
Study Design:  Prospective case series without control
Level IV - Favorable
Supports IDET:  Although various alterations in outcome scores have been reported in previous works, we found nearly four in five patients (79.48%) who clearly benefited from this therapy. This procedure may become a middle step for carefully selected group of patients who failed non-operative treatment before surgical intervention.

9.  Pain Physician. 2003 Oct;6(4):443-8
Intradiscal electrothermal therapy (IDET) for treatment of chronic lumbar discogenic pain: a minimum 2-year clinical outcome study.
Lee MS, Cooper G, Lutz GE, Lutz C, Hong HM.
Hospital for Special Surgery, 535 East 70th St., New York, NY 10021, USA. leemi@hss.edu
Study Design:  Prospective case series clinical outcome study
Level IV - Favorable
Supports IDET:  Overall, there was statistically significant improvement in LB-VNS, RM, and LE pain scores of 3.2, 6.6, and 2.3 (p<0.001), respectively. Twenty-seven of 51 (53%) patients demonstrated clinically significant VNS and RM improvements of greater than 2. On NASS index, 63% (32/51) responded positively.  IDET appears to be an effective treatment for chronic lumbar discogenic pain in a well-selected group of patients with favorable long-term outcome.

10.  WMJ. 2005 Aug;104(6):39-46
Intradiscal electrothermal annuloplasty therapy: a case series study leading to new considerations.
Bryce DA, Nelson J, Glurich I, Berg RL.
Advanced Pain Management, Cudahy, WI 55110, USA. dbryce@meriter.com
Study Design:  Case Series
Level IV - Favorable
Supports IDET (IDEA):  These data show favorable outcomes after IDEA therapy, and suggest that women may experience more improvement than men, particularly with regard to perceived disability improvements. Data suggest that greater improvement in IDEA outcomes may be achieved by profiling the characteristics of patients who achieve the optimal long-term outcomes following treatment and should be considered during evaluation of patient eligibility for IDEA.

11.  Spine. 2003 Jun 1;28(11):1142-7
Risk factors for failure and complications of intradiscal electrothermal therapy: a pilot study.
Cohen SP, Larkin T, Abdi S, Chang A, Stojanovic M.
Pain Management Center, Department of Anesthesia, Walter Reed Army Medical Center, Washington, DC, USA.
Steven.Cohen@med.nyu.edu
Study Design:   case series
Level IV - Favorable
Supports IDET:  Forty-eight percent of patients reported more than 50% pain relief at their 6-month follow-up. There were eight complications (10%), most of which were self-limited and transient. The only risk factor associated with intradiscal electrothermal therapy failure was obesity (P = 0.01). Whereas 54% of nonobese patients reported good pain relief at 6 months, only one out of 10 obese patients had successful intradiscal electrothermal therapy. The obese patients in our study were more likely to have a complication from intradiscal electrothermal therapy than they were to obtain pain relief.

12.  Pain Pract. 2004 Jun;4(2):84-90
Intradiscal thermal annuloplasty for discogenic pain: an outcome study.
Mekhail N, Kapural L.
Department of Pain Management, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. 5mekhain@ccf.org
Study Design:  Prospective Case series study
Level IV - Favorable
Supports IDET:  We found dramatic improvement of pain scores and ADLs following IDTA when strict patient
selection was applied. We believe that IDTA is an effective, minimally invasive treatment for discogenic pain in
properly selected patients.

13.  Pain Med. 2005 Nov-Dec;6(6):425-31
Intradiscal thermal annuloplasty versus intradiscal radiofrequency ablation for the treatment of discogenic pain: a prospective matched control trial.
Kapural L, Hayek S, Malak O, Arrigain S, Mekhail N.
http://www3.interscience.wiley.com/journal/118716334/abstract
Department of Pain Management, The Cleveland Clinic FoundatioN, Cleveland, Ohio 44195, USA. kapural@ccf.org
Study Design:  Prospective poor control matched. (non-placebo)
Level IV - Favorable
Supports IDET:  This study shows significant improvement in pain scores and patients' PDI following IDTA but not after RFA of the intervertebral disks. IDTA appears to be more efficacious than RFA based on PDI and VAS scores measured at 1 year following procedure.

14.  Pain Physician. 2000 Oct;3(4):367-73
Intradiscal electrothermal therapy: a preliminary report.
Singh V.
http://www.painphysicianjournal.com/crrent_issue_vw.php?journal=5&code=305&issue=past_issue
Pain Diagnostic Associates, 1601 Roosevelt Road, Niagara, WI 54151, USA.
Study Design:  case series
Level IV - Favorable
Supports IDET:  The results showed greater than 50% pain relief in 67% of the patients. In addition, a significant
decrease in visual analog pain scores was also seen. Further, the assessment of functional status showed significant improvement with standing and walking, whereas sitting also demonstrated significant improvement in 62% of the patients, though it was not statistically significant. Intradiscal electrothermal therapy is a safe and effective procedure in patients suffering with chronic functionally limiting discogenic pain who fail to respond to aggressive conservative modalities of treatments as well as interventional therapy with injections.

Level V:  3 Studies

1.  Clin Sports Med. 2002 Jan;21(1):167-87
Intradiscal electrothermal therapy for the treatment of chronic discogenic low back pain.
Saal JA, Saal JS.
Study Design:  Expert Opinion
Level V - Favorable
Supports IDET:  The cost, morbidity, and currently observed degree of effectiveness make IDET an attractive
alternative to spinal fusion for discogenic pain.

2.  Neurosurg Focus. 2002 Aug 15;13(2):E7
Alternative strategies for lumbar discectomy: intradiscal electrothermy and nucleoplasty.
Welch WC, Gerszten PC.
Department of Neurological Surgery and Orthopaedic Surgery, School of Rehabilitative Sciences, University of
Pittsburgh Medical Center-Health System, Presbyterian University Hospital, Pittsburgh, Pennsylvania, USA. wwelch@neuronet.pitt.edu
Study Design:  Expert Opinion
Level V - Favorable
Supports IDET: The IDET procedure may be an alternative to lumbar interbody fusion. Although its long-term role is being defined, this technique appears to provide intermediate-term relief of pain in a population of patients with
discogenic low-back pain. 

3.  Pain Physician. 2008 Sep-Oct;11(5):659-68
Intradiscal electrothermal therapy (IDET) for the treatment of discogenic low back pain: patient selection and indications for use.
Kloth DS, Fenton DS, Andersson GB, Block JE.
http://www.painphysicianjournal.com/crrent_issue_vw.php?journal=45&code=1137&issue=past_issue
Connecticut Pain Care, Danbury, CT, USA.
Study Design:  Expert Opinion
Level V - Favorable
Supports IDET:  Indications for use were developed from review of selection criteria from published clinical reports and review articles of IDET, and further refined by identifying components with the strongest positive predictive value and by direct physician feedback.  Using these patient selection characteristics, approximately 3 of 4 IDET-treated patients should achieve a minimal clinically important improvement in pain and disability.

IDET - INTRADISCAL ELECTRO-THERMY
Studies Unfavorable:  Total 7

Level I:  2 Studies

1.  A Randomized, Double-Blind, Controlled Trial: Intradiscal Electrothermal Therapy Versus Placebo for the Treatment of Chronic Discogenic Low Back Pain
Freeman, Brian J. C. FRCS (Tr & Orth); Fraser, Robert D. MD, FRACS; Cain, Christopher M. J. MD, FRACS; Hall, David J. FRACS; Chapple, David C. L. MSc, FRCS (Tr & Orth)
Spine. 30(21):2369-2377, November 1, 2005.
Study Design: A prospective, randomized, double-blind, placebo-controlled trial
Level I - Unfavorable
Against IDET:  Fifty-seven patients were randomized with a 2:1 ratio: 38 to IDET and 19 to sham procedure (placebo).  This study demonstrates no significant benefit from IDET over placebo.

2.  Eur Spine J. 2006 Aug;15 Suppl 3:S448-57. Epub 2006 Jul 26
IDET: a critical appraisal of the evidence.
http://www.springerlink.com/content/p2p4668510212498/?p=e942f621450945f9bb1c54f7d16e9241&pi=19
Freeman BJ.
Centre for Spinal Studies and Surgery, Queen's Medical Centre, University Hospital, Nottingham, UK. brian.freeman@nuh.nhs.uk
Study Design:  Systematic Review of 4 star and 5 star studies
Level I - Unfavorable
Against IDET:  The evidence for efficacy of IDET remains weak and has not passed the standard of scientific proof.

Level II:  1 Study

1.  Spine. 2007 May 1;32(10):1146-54
Percutaneous thermocoagulation intradiscal techniques for discogenic low back pain.
Urrútia G, Kovacs F, Nishishinya MB, Olabe J.
Centro Cochrane Iberoamericano, Servei d'Epidemiologia i Salut Pública, Hospital de la Santa Creu i Sant Pau,
Universitat Autònoma de Barcelona, Barcelona, Spain. gurrutia@santpau.es
Study Design:  Systematic Review of 4 and 5  star studies
Level II - Unfavorable
Against IDET:  The available evidence does not support the efficacy or effectiveness of percutaneous
thermocoagulation intradiscal techniques for the treatment of discogenic low back pain.

Level III:  1 Study

1.  The IDET Procedure for Chronic Discogenic Low Back Pain
Davis, Timothy T. MD; Delamarter, Rick B. MD; Sra, Parveen MPH; Goldstein, Theodore B. MD
Spine. 29(7):752-756, April 1, 2004.
Study Design:  Retrospective study with independent evaluation of patient outcomes approximately 1 year post-intradiscal electrothermal therapy (IDET).
Level  III - Unfavorable
Against IDET:  At 1-year post-IDET, half of patients were dissatisfied with their outcome.

Level IV:  3 Studies

1.  Vertebral Osteonecrosis Associated With the Use of Intradiscal Electrothermal Therapy: A Case Report
Djurasovic, Mladen MD; Glassman, Steven D. MD; Dimar, John R. MD; Johnson, John R. MD
Spine. 27(13):E325-E328, July 1, 2002.
Study Design:  Case report
Level IV - Unfavorable
Against IDET:  Clinicians should be advised that intradiscal electrothermal therapy can be associated with
complications, which in the current case, led to osteonecrosis of the vertebral body.

2.  Spine J. 2003 Nov-Dec;3(6):502-9
Intradiscal electrothermal therapy (IDET) for chronic low back pain in active-duty soldiers: 2-year follow-up.
Freedman BA, Cohen SP, Kuklo TR, Lehman RA, Larkin P, Giuliani JR.
Department of Orthopaedic Surgery and Rehabilitation, Walter Reed Army Medical Center, Washington, DC 20307, USA. brett.freedman@na.amedd.army.mil
Study Design:  Case Series
Level IV - Unfavorable
Against IDET:  The success rate was 47% (17 of 36) at 6 months and 16% (5 of 31 patients) at latest follow-up.
Although overall success rates were low, 20 of 31 soldiers (65%) had a persistent decrease in their analog pain score (average decrease of 2.5+/-1.6 on a 10-point scale), with 52% having 2-point or greater decrease. Nineteen of 31 soldiers (61%) were still on active duty at a minimum of 24 months after IDET. There were five transient complications (16%) from IDET, all reported within the first month. Seven of 31 soldiers (23%), all male, went on to spinal surgery within 24 months of failed IDET.  IDET is not a substitute for spinal fusion in the treatment of chronic discogenic low back pain in active-duty soldiers.

3.  Eur Spine J. 2002 Dec;11(6):589-93. Epub 2002 Aug 9
Pain and function after intradiscal electrothermal treatment (IDET) for symptomatic lumbar disc degeneration.
Spruit M, Jacobs WC.
Orthopedic Research Unit, Sint Maartenskliniek Research, Sint Maartenskliniek PO Box 9011, 6500 GM Nijmegen, The Netherlands.
Study Design  case series
Level IV - Unfavorable
Against IDET:  Twenty consecutive patients with symptomatic degenerative discs were treated with IDET and evaluated preoperatively, and 3 and 6 months postoperatively. Pain was measured with a 100-mm visual analog scale (VAS) and function was evaluated with the Oswestry score and SF-36 questionnaire. The VAS scores improved by 14 mm on average (P=0.046), but the individual scores show great variation. The Oswestry scores did not improve significantly. The SF-36 showed improvement, but only for the subscales vitality (P=0.023) and bodily pain (P=0.047).  IDET is not effective in reducing pain and improving functional performance in a sample of 20 patients treated for chronic discogenic low back pain after 6 months follow-up.

IDET - INTRADISCAL ELECTRO-THERMY
Studies Neutral:  Total 5

Level I:  1 Study

1.  Spine J. 2004 Jan-Feb;4(1):27-35.
A randomized, placebo-controlled trial of intradiscal electrothermal therapy for the treatment of discogenic low back pain.
Pauza KJ, Howell S, Dreyfuss P, Peloza JH, Dawson K, Bogduk N.
Texas Spine and Joint Hospital, 1814 Roseland Boulevard, Tyler, TX 75701, USA. kevinpauza@tyler.net
Study Design:  Randomized, placebo-controlled trial
Level I - Neutral
Neutral IDET: approximately 50% of the patients with IDET experienced no appreciable benefit

Level II:  1 Study

1.  Pain Physician. 2004 Jan;7(1):63-6.
Comparison of intradiscal restorative injections and intradiscal electrothermal treatment (IDET) in the treatment of low back pain.
Derby R, Eek B, Lee SH, Seo KS, Kim BJ.
Spinal Diagnostics and Treatment Center, 901 Campus Drive, Suite 312, Daly City, CA 94015, USA. rderby@spinaldiagnostics.com
Study Design:  Randomized prospective with poor control group (non-placebo control)
Level II - Neutral
Neutral to IDET:  Pain relief was statistically significant for both procedures, but slightly better for injections (2.2 VAS) than for IDET (1.27 VAS). 47.8% of IDET patients reported that they felt better, whereas 65.6% of injection patients reported this outcome. Among IDET patients, 35.8% reported they were worse, while no restorative injection patient reported worsening of pain. Post-procedure flare-up occurred more frequently after restorative injection (81%) than after IDET (68.9%) and was more severe (7.9 versus 6.1 VAS, respectively). However, the duration of pain flare-up was notably shorter for restorative injections (8.6 days) than for IDET (33.1 days).  The results of this study indicate that controlled random prospective comparative studies need to be performed to establish the efficacy of this treatment.

Level IV:  2 Studies

1.  Outcomes of Workers' Compensation Claimants With Low Back Pain Undergoing Intradiscal
Electrothermal Therapy
Webster, Barbara S. BSPT, PA-C; Verma, Santosh MD, MPH; Pransky, Glenn S. MD, MoccH
Spine. 29(4):435-441, February 15, 2004.
Study Design: Case series
Level IV - Neutral
Neutral. The procedure may be less effective when performed by a variety of providers than suggested by initial case series performed by single providers or practices in work-related LBP cases. Provider self-referral and narcotic use before IDET are significant risk factors for poor outcomes.

2.  Yonsei Med J. 2005 Aug 31;46(4):539-45
Intradiscal electrothermal treatment for chronic lower back pain patients with internal disc disruption.
Park SY, Moon SH, Park MS, Kim HS, Choi YJ, Lee HM.
Department of Orthopedic Surgery, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu,
Seoul 120-752, Korea. hwanlee@yumc.yonsei.ac.kr.
Study Design:  case series
Level IV - Neutral
Neutral to IDET:  Although other studies have shown good results with IDET for at least 2 years, this investigation suggests the IDET may be somewhat less effective. In order to firmly establish the efficacy of IDET for treating chronic discogenic lower back pain, additional studies with larger numbers of patients evaluated over longer time periods are recommended.

Level V:  1 Studies

1.  Pain Pract. 2005 Sep;5(3):228-43
Intradiscal electrothermal coagulation and percutaneous neuromodulation therapy in the treatment of
discogenic low back pain.
Rozen D, Grass GW.
Department of Anesthesiology and Pain Medicine, Mount Sinai Medical Center, New York, New York 10029-6574, USA. dimarozen@hotmail.com
Study Design:  Expert Opinion with  non systematic lit review
Level V - Neutral
Neutral to IDET:  Early biomechanical and histologic investigations into the effects of IDET are conflicting. However, in early prospective human trials, IDET seems to provide some benefit with little risk.  More basic science and clinical research with long-term follow-up evaluation is necessary.