Impairment Tutorial: Rating After IDET Procedures: Rating Permanent Impairment in Patients Who Have Already Had Intra-discal Electrothermal Annuloplasty (IDET) Procedures
James B. Talmage
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Robert H. Haralson III
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Abstract

Intra-discal electrothermal annuloplasty (IDET) is a relatively recently described surgical procedure for chronic low back pain that is caused by degenerative discs is unresponsive to nonoperative treatment. IDET involves percutaneously inserting a catheter into a disc(s) and then heating the catheter to 90 °C for 17 minutes. Randomized controlled trials are in progress but not yet reported, so the proper role of IDET in the care of chronic back pain is not yet known. Neither the Fourth nor the Fifth Edition of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) specifically addresses IDET. Evaluators who use the AMA Guides, Fifth Edition, apply the Diagnosis-related estimates (DRE) method to assess impairment when the patient is at maximum medical improvement (MMI). Because the long-term effects of IDET are not known and the patient's disc probably has been permanently changed by the procedure, evaluators should consult the AMA Guides, Fifth Edition, regarding categorization. This is because the injury and surgery have not resulted in a normal disc but rather one that may be prone to future problem episodes. If the evaluator chooses to use the range-of-motion method from the AMA Guides, Fourth Edition, in some scenarios the authors recommend considering IDET as if it were “surgical treatment” of the disc.

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    Saal JA, Saal JS. Intradiscal electrothermal treatment for chronic discogenic low back pain. Spine. 2000;25:26222627.

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    Talmage JB. Rating post-operative backs (Part I). The Guides Newsletter. July/August 1997;13. Talmage JB. Postoperative backs: common impairment rating scenarios (Part II). The Guides Newsletter. September/October 1997;13.

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  • 3.

    Kleinstueck FS, Diederich CJ, Nau WH, et al. Acute biomechanical and histological effects of intradiscal electrothermal therapy on human lumbar discs. Spine. 2001; 26:21982207.

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