Abstract
Objectives: To describe a new method of catheter insertion in Intradiscal Electrothermal Therapy (IDET), when and adequate catheter position cannot be achieved with standard technique. Intradiscal Electrothermal Therapy is a new technique developed in 1998 for treatment of chronic low back pain. Adequate catheter position is of vital importance to the outcome of this procedure. If adequate position is not achieved with the standard technique, the recommendation is to reinsert a new cannula into the contralateral side. This requires more local anaesthesia, further discomfort for the patient and additional X-ray exposure. The “Pig Tail” Technique described here, eliminates the need for reinsertion of the cannula and catheter from the contralateral side in those patients in whom optimal positioning is not achieved with the standard technique. This new technique has not been described before.
Methods: In those patients in whom adequate catheter position cannot be achieved with the standard technique, instead of withdrawing the cannula after the initial treatment, we recommend rotating the cannula 180° through its long axis. This will allow the catheter to hit the anterior annulus and deflect backwards towards the cannula. It can then be negotiated across the midline to adequately thermally treat the whole posterior annulus.
Results: We have performed our technique in thirty two consecutive patients in whom initial navigation was difficult. This new method proved to be simple and did not cause patients additional discomfort.
Conclusion: “Pig Tail” Technique is safe and effective in IDET of those patients with difficult navigation. It avoids the need for second needle insertion therefore avoiding the use of more local anaesthsia, further discomfort for the patient and additional X-ray exposure.
Correspondence should be addressed to the editorial secretary: Dr Charles Pither, c/o British Orthopaedic Society, Royal College of Surgeons, 35-43 Lincoln’s Inn Fields, London WC2A 3PN.
