Historical Perspective

Developed in the 1990s as a minimally invasive treatment for chronic discogenic low back pain refractory to conservative measures,3 the IDET technique involves intradiscal delivery of thermal energy to the internal structure of the disc annulus by way of a catheter placed within

Figure 7.3. A commercially available annuloplasty catheter, the Oratec SpineCath wand. This flexible conductive catheter has an exposed resistive heating element on the terminal 2 inches. The catheter has a hockey stick curve to facilitate navigation along the inner aspect of the annulus.

the disc (Figure 7.3). Delivery of thermal energy is a common technique used in pain management, surgery, and tissue ablation.17 It has been shown in vivo to shrink and reorient collagen fibrils, coagulate nervous tissue, and cauterize fibrous tissue. Extensive in vivo studies have demonstrated the IDET method to be a safe technique for application of thermal energy to the disc annulus for the purpose of shrinking disc substance, promoting annular healing, and coagulating nervous tissue in the annulus in the course of treating discogenic pain.3,18-21 The first case was performed in 1997 with institutional review board approval; approval by the U.S. Food and Drug Administration was granted in 1998.

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