Intra-Discal Electrocaudery Therapy (IDET)
is a necessary indication for I
) where a coil is introduced into the disk to burn the annulus fibrosis in the area of the theorized internal disk disruption.
Posterolateral fissures occur in annulus of the disc (left). Needle with wire is passed percutaneously into the disc (center) and IDET wire to cauterize to denervate and provoke repair behind the fissure (right) but heat was found inadequate to cauterize by Freeman et al.,`03.
Considering the lack of discrimination available with discography it is no wonder that now 3 controlled trial attempts providing no evidence of clinical efficacy for the IDET theory despite what once seemed as overwhelming retrospective results published before the prospective trials (Pauza et al., 2004, Lau et al.,2004, Freeman et al. 2005
). Despite how the Pauza abstract reads, there was a lack of any clinical significance in his study for IDET as was evinced further double blinded efforts by Freeman
and the stopped Lau
study for lack of trend). Pauza et al`04
without blinding the provider, found statistical significance is only based upon a 1.5/10 difference compared to the controls noted on a Visual Analog Scale
using high mean of about 6/10 rather than 10/10 as the range, but this provides no clinical significant difference.
The most reliable literature (trials and prospective cohort studies) condemn invasive treatment predicated upon discography.
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