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MRI and CT scans can reveal disc anatomy but do not determine which discs cause pain. Fluoroscopic techniques called discography allow the specialist to place fine needles into the center of discs suspected of generating pain. These discs can then be injected with x-ray contrast to visualize disc anatomy in real time and to determine pain response to pressure, a process known as discography. A normal disc does not cause pain when pressure is applied, whereas a pain-generating disc will reproduce the patient's typical pain with pressure.
IDET is a recently developed alternative to discectomy for repair of deteriorated lumbar discs. The IDET procedure involves placing a wire into the disc annulus and heating the internal annulus to a high temperature for 14 to 17 minutes. This heating process contracts the collagen material within the annulus, thus making the annulus firmer and more secure. Simultaneously, the heat is thought to destroy the abnormal pain-sensing nerve fibers within the disc, thereby reducing the pain. IDET is indicated for patients with chronic, disabling low-back pain caused by degenerating lumbar discs, when pain is unresponsive to more conservative interventions.
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