Frequently, neurological pain is discussed in connection with herniated discs; as fluid leaks out from the center of the disc, it irritates nearby nerves and causes pain, tingling, numbness and weakness along the nerve pathway. Sciatica, for example, is often caused by disc herniation in the lumbar spine. But herniated disks do not always affect nerves. Sometimes, they're asymptomatic and sometimes, any pain they cause may be localized.
Just as the fluid inside spinal disks can irritate nerves exiting the spine, it can also irritate nerves located in the outer shell of the disc. It is even theorized that, when a disc cracks, the nerves from the outer shell may begin to grow into the disc, bringing themselves to the fluids inside.
A cracked disc that causes localized pain without neurological symptoms is usually treated with physical therapy and pain medication. For some, however, pain stubbornly persists. If you've used conservative means for up to 6 months with no success, your pain is severe and you're facing activity restrictions, such as the inability to work, then you may be a candidate for intradiscal electrothermal annuloplasty.
Intradiscal Electrothermal Annuloplasty (IDET)
Although minimally invasive, IDET is still a surgical procedure; it should not be a first line of treatment. That said, for people facing the prospect of more invasive procedures or a lifetime of narcotic medication, it may be a sounder alternative. This procedure is specifically for people with minor disc tears at one spinal level.
The goals of IDET are 1) to cauterize nerves within the disc's outer shell, thereby relieving pain, and 2) to encourage minor tears to close up by thickening the collagen within the disc wall. It accomplishes these goals with the application of heat. A hollow needle is inserted into the back, and a heating catheter is placed through it against the wall of the disc. The catheter is heated to 194 degrees Fahrenheit for under 20 minutes.
If IDET is successful, it may take some time – 6 to 8 weeks – to really feel improvements. Although the whole procedure takes only about an hour, you can expect activity modification for a good half year after the procedure. According to research compiled by Spine-Health.com, the surgery has a 60-74% satisfaction rate among recipients. See more on this at http://www.spine-health.com/treatment/back-surgery/what-known-about-outcomes-idet-research-article .
Like all invasive procedures, IDET comes with risks. The disc may become infected, or neighbors nearby may be damaged. These are expected to occur less than 1% of the time. What should be noted is that discography – the injection of dye into a disc to illuminate areas of dysfunction often done before IDET – has been linked to increased rate of disc degeneration in the future. See more on this at http://www.ncbi.nlm.nih.gov/pubmed/19755936 . Talk to your surgeon about alternatives to discography.
Conservative treatments are always best, but for those facing the prospect of more invasive measures, IDET could be the most conservative option. Make sure you know all your options and all associated risks before pursuing a treatment.