A Minimally Invasive Treatment for Lumbar Disc Herniation: DiscoGel® Chemonucleolysis in Patients Unresponsive to Chemonucleolysis with Oxygen-Ozone

Abstract

<jats:p> A multitude of therapies is available to treat disc herniation, ranging from conservative methods (medication and physical therapy) to minimally invasive (percutaneous) treatments and surgery. O<jats:sub>2</jats:sub>-O<jats:sub>3</jats:sub> chemonucleolysis (O<jats:sub>2</jats:sub>-O<jats:sub>3</jats:sub> therapy) is one of the minimally invasive treatments with the best cost/benefit ratio and lowest complication rate. Another substance recently made available exploiting the chemical properties of pure ethanol is DiscoGel®, a radiopaque gelified ethanol more viscous than absolute alcohol <jats:sup>8,9</jats:sup>. The present study aimed to assess the therapeutic outcome of DiscoGel® chemonucleolysis in patients with lumbar disc herniation unresponsive to O<jats:sub>2</jats:sub>-O<jats:sub>3</jats:sub> therapy. </jats:p><jats:p> Thirty-two patients aged between 20 and 79 years were treated by DiscoGel® chemonucleolysis between December 2008 and January 2010. The treatment was successful (improvement in pain) in 24 out of 32 patients. </jats:p><jats:p> DiscoGel® is safe and easy to handle and there were no complications related to product diffusivity outside the treatment site. </jats:p><jats:p> The therapeutic success rate of DiscoGel® chemonucleolysis in patients unresponsive to O<jats:sub>2</jats:sub>-O<jats:sub>3</jats:sub> therapy was satisfactory. Among other methods used to treat lumbar disc herniation, DiscoGel® chemonucleolysis can be deemed an intermediate procedure bridging conservative medical treatments and surgery. </jats:p>

Percutaneous Injection of Radiopaque Gelified Ethanol for the Treatment of Lumbar and Cervical Intervertebral Disk Herniations: Experience and Clinical Outcome in 80 Patients

“…In LDH, Volpentesta et al 10 reported excellent and good results in 80.4% of 72 patients, despite complications in 5.45%. Theron et al 6 reported a success rate of 91.4% in a group of 221 patients and a complication rate of Ͻ0.5%, while Stagni et al 8 achieved a therapeutic success in 24 of 32 treated patients (75%) without complications. In CDHs, Theron et al 7 reported a success rate of 89.5% in 57 patients without complications.…”

“…RGE, instead, makes the alcohol solution much easier to handle and reduces the need for diskography. 8 Notably, even in the largest herniations that are potentially "surgical," we did not consider the annulus integrity necessary, because RGE can spread to the more isolated disk compartments, leading to good results. In this subset of patients, the results have been encouraging, with convincing symptom improvement.…”

“…Recently, a newly developed substance, radiopaque gelified ethanol (RGE), has been introduced into clinical practice. [6][7][8][9][10] RGE is a viscous solution containing ethyl alcohol and cellulose derivative products associated with a contrast agent (tungsten). Clinical outcomes seem to be encouraging, with a high reduction of possible collateral effects.…”

Distribution and Short‐ and Long‐term Effects of Injected Gelified Ethanol Into the Lumbosacral Intervertebral Disc in Healthy Dogs

“…A radiopaque gelified ethanol product (Discogel, Gelscom, France) has recently been developed for percutaneous injectable treatment of intervertebral disc herniation in human patients . In preliminary clinical studies involving over 400 humans, 75–91% of patients reported improvement of symptoms with no adverse effects following treatment with radiopaque gelified ethanol . It is theorized that the ethanol results in molecular splitting of the proteoglycans in the nucleus pulposus, causing a reduction in the nuclear volume and regression of the protrusion .…”

Percutaneous bipolar radiofrequency thermocoagulation for the treatment of lumbar disc herniation

“…Recently, technological advances in minimally invasive spine surgery have emerged [5,6]. Common minimally invasive (percutaneous) techniques include hemodiscolysis with chymopapain, Onik's automated percutaneous lumbar discectomy, percutaneous laser disc decompression, intradiscal electrothermal therapy, percutaneous coblation nucleoplasty, Dekompressor percutaneous lumbar discectomy (Stryker, Kalamazoo, MI, USA), and intradiscal oxygen-ozone therapy [7,8]. These techniques include two surgical approaches, namely intradiscal decompression and extradiscal ablation [9][10][11].…”