Patients who have concomitant chronic back pain with significant radiculopathy (Internal Disc Derangement-IDD and disc herniation) were considered candidates for combined therapy with Percutaneous Non-traumatic Discectomy-PED and IntraDiscal Electro Thermal Therapy-IDET (Oratec Corp).

Six Patients with lumbar disc herniation and IDD underwent PED and IDET in an outpatient setting with conscious sedation and local anesthesia performed in the prone or lateral position. Subjects met the following criteria: MRI showing disc herniation and discography with CT also confirming annular fissuring; back pain with radiculopathy lasting > 6 months; and failure of an aggressive non-operative care plan therefore meeting the candidacy profile given by Saai and Saal, IDET Training Course Syllabus, 1999; 39-40. The length of symptomatology in this study group ranged from 12-84 months. None had previous surgery at the involved levels. The endoscope used is shown on page 590; Ditsworth, DA. Endoscopic Transforaminal Lumbar Discectomy and Reconfiguration: A Posterolateral Approach into the Spinal Canal, Surgical Neurology, 1998; 6: 588-598.

Initial results in this small group are encouraging. Early results indicate that the patient outcomes are better than the typical IDET curve with no complications. Risk of injury due to manipulation causing catheter failure or breakage is avoided with the endoscope.

There is a group of patients that meet the criteria for both procedures (PED and IDET). Percutaneous endoscopy treats the herniated disc and also provides visualualized, improved access and prepares the bed for the IDET catheter. This combination technique represents a new treatment for a double disorder.