Proper patient selection is critical for successful outcomes

The IDET procedure is appropriate for patients with chronic discogenic lower back pain who have failed a program of aggressive non-operative therapy. A survey of prospective case series, randomized trials, and published guidelines suggests consideration of the following entry criteria after ruling out “red flag” pathologies (cancer, infection, ankylosing spondylitis) and other causes such as rheumatoid arthritis, ambulatory dysfunction, or inflammatory arthritides:

• Internal disc disruption; small, contained disc herniation; degenerative disc disease at one or two levels.
• Mostly axial low back pain, greater than leg pain for 3-6 months.
• Failure to improve after > 6 weeks of conservative treatment.
• Discogenic pain confirmed by provocation discography.
• Preservation of > 50% of disc height.
• Normal neurologic exam.
• Patient willing and able to comply with post-IDET-procedure recovery regimen.

Prior surgery at the affected disc level, failed fusion surgery, spinal stenosis, large or extruded disc herniation, and physical deformities (eg, scoliosis, kyphosis, and spondylolisthesis) are generally considered contraindications to the IDET procedure. Major trials from which these entry criteria were distilled are summarized in Clinical Studies of the IDET Procedure. As you engage in the patient selection process, you may also wish to review criteria for differential diagnosis.