Intradiscal electrothermal therapy (IDET) for thoracolumbar disc herniation: a case report highlighting IDET as a viable alternative to invasive surgery in a 75-year-old patient with a high Charlson comorbidity index

Intradiscal electrothermal therapy (IDET) is a minimally invasive procedure commonly used to treat discogenic back pain caused by annular disruption or contained disc herniation.However, its role in extruded disc herniation remains controversial and is generally considered limited.A 75-year-old woman presented with severe back pain caused by a centrally extruded and superiorly migrated T12-L1 disc herniation that was refractory to conservative treatment.She had multiple comorbidities, including diabetes mellitus, chronic kidney disease, Parkinson's disease, prior myocardial infarction, and severe chronic obstructive pulmonary disease, resulting in a Charlson Comorbidity Index score of 9.Because of her high surgical risk, conventional spine surgery was considered unsafe, and IDET was selected as an alternative treatment.The procedure was performed under local anesthesia using a fluoroscopy-guided posterolateral approach.A guide needle and catheter were introduced into the T12-L1 disc space, and thermal energy was delivered to the affected region without procedural complications.Following IDET, the patient's numerical rating scale pain score improved from 8 to 3. Follow-up magnetic resonance imaging demonstrated a 42.14% reduction in the volume of the herniated disc.This case suggests that IDET may be a feasible and less invasive treatment option for carefully selected patients with extruded thoracolumbar disc herniation who are not candidates for conventional surgery.Although extruded disc herniation has traditionally been considered a contraindication, IDET may provide meaningful clinical and radiographic improvement in selected high-risk patients.