May 2019 Edition. Volume XIX


Few minimally invasive procedures have burst upon the scene with as much good press, hoopla and hype as IDET (since the advent of the procedure chemonucleolysis with chymopapain).

The image above from the March 15, 1999 issue of Newsweek on IDET does an excellent job of illustrating and touting the procedure but has IDET suvived the test of time and scrutiny?  Was it really an alternative to fusion as the article suggests?

There was no question but that intradiscal electrothermal coagulation therapy (IDET) was minimally invasive and carried with it significantly less patient risk than many other “minimally invasive” therapeutic modalities.  With IDET the major liability was that it  really didn’t accomplish it goal of pain relief and turned out to be expensive.

IDET did not survive time and clinical experience and has “fallen into disuse” and faded from medical memory.

There are other minimally invasive therapies which have also faded into medical memory in the U.S.  One of the most prominent of these has been Chemonucleolysis with Chymopapain -which actually can be a cost-effective therapeutic agent for the treatment of lumbar herniated discs but, ran into safety problems when chymopapain was inadvertently injected into nerves or the subarachnoid space producing nerve injury, paraplegia and stroke.  It was because of complications such as this that the use of chymopapain “fell into disuse.”

Epidural Steroid Injections
when neurotoxic materials, such as steroid preparations containing glycols, are injected into the human subarachnoid space they cause a chemical meningitis reaction reflected by arachnoiditis.  In advanced cases this can result in a lifetime of agonizing pain due to adhesive arachnoiditis. Ill-advised blind Epidural steroid injections with neurotoxic continues in the U.S. and has not yet (remarkably) “fallen into disuse.”

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