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Intradiscal electrothermal therapy is a procedure of applying heat to the annulus in cases of low back pain due to discogenic conditions that fail to respond to non-operative techniques. This activity describes the intradiscal electrothermal therapy technique, highlighting the role of the interprofessional team in evaluating and improving care for patients who undergo this lumbar minimally invasive procedure. Objectives: Identify the anatomical structures, indications, and contraindications of intradiscal electrothermal therapy. Identify the equipment, personnel, preparation, and technique in regards to intradiscal electrothermal therapy. Review the appropriate evaluation of the potential complications and clinical significance of intradiscal electrothermal therapy. Describe strategies for improving care coordination and communication among members of the interprofessional team for patients undergoing Intradiscal intradiscal electrothermal therapy to foster optimal patient care. Access free multiple choice questions on this topic.

Low back pain (LBP) is a very common and disabling disorder. Many causes of low back pain differ depending on the patient population; mechanical conditions are the most common ones, including facet joint disease, discogenic pain, spinal stenosis, disc herniations, and spondylolysis.  Discogenic pain accounts for 30 to 40% of patients with LBP, and multiple interventional therapies have been developed to treat this condition.[1] Intradiscal electrothermal therapy (IDET) is a minimally invasive surgical (MIS) procedure for the treatment of discogenic chronic low back pain. The technique involves applying heat to the annulus fibrosus through a catheter with a temperature-controlled thermal resistive heating coil. The goal of thermal disc treatment is to damage the nerve fibers, shrink collagen, and stiffen the disc tissue; this might seal any small tears and limit the expression of matrix components.[2]

Discography and IDET procedures are associated with very low complication rates. Related-technique complications include[7][12]: Radiculopathy. Accelerated disc degeneration Endplates deformation Spondylodiscitis Transthecal puncture route may result in post-procedural headache Vertebral osteonecrosis -Cauda equina syndrome

Before IDET consideration, patients should have treatment with a comprehensive exercise training regimen and an optimized regimen of medications such as nonsteroidal anti-inflammatory drugs. The performance of the IDET procedure requires collaboration from all members of the interprofessional medical team. Although a relatively safe procedure, all involved members of the interprofessional team need to communicate across interprofessional lines such as nursing staff working together with physicians and anesthesiologists to provide the highest level of care and patient comfort during the procedure. [Level 5] Pain relief after IDET is not immediate. Furthermore, it may increase during the first couple of days. Physical therapy is a crucial aspect of recovery, and the PT should keep the rest of the team appraised of patient progress. Orthopedic specialized nursing staff can counsel and direct the patient following the procedure, and coordinate with the PT afterward as rehab begins. During the first month after IDET, 5the patient can plan to walk and do easy stretches. During the first 2 to 3 months, the patient should exercise as directed, and avoid lifting, bending, and long periods of sitting. It is recommendable for patients who have had IDET to wait at least 5 to 6 months to return to vigorous sports such as skiing, running, or tennis.[18] The best possible outcome for patients undergoing IDET could be encouraged through clear and efficient communication and collaboration among the members of the interprofessional team, as outlined above. [Level V]

The patient should receive appropriate information about what to expect before, during, and after an IDET procedure. Before the start of the procedure, the patient should be interviewed about the type, location, and nature of the pain, and any history of prior surgery. Preoperative instructions such as procedure time, shower or skin preparation, which routine medications to take and hold, prophylactic antibiotics, or anticoagulants, anesthesia premedication. Remove jewelry preoperatively or tape over as appropriate. For the IDET procedure, it has to be taken into consideration that metals conduct electrical current and provide an electrocautery hazard. Secure patient on the OR table with a safety belt as appropriate, explaining the necessity for restraint.

The role of the nurse in the pre and postoperative period should include finite management of intravenous fluids, administering intravenous antibiotics, pain control, wound/dressing care and encouraging patient ambulation, initiate necessary lifestyle changes and participate in an early treatment regimen. Perioperative nursing monitoring is essential in this outpatient procedure, such as accurate follow-through of instructions/development of preventable complications. After the procedure is completed, monitoring of vital signs is also performed by the nurse.