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

Bellini, Matteo; Romano, Daniele Giuseppe; Leonini, Sara; Grazzini, Irene; Tabano, C.; Ferrara, Marco; Piu, Pietro; Monti, Lucia; Cerase, Alfonso

doi:10.3174/ajnr.a4166

Cited by 27 publications

(28 citation statements)

References 14 publications

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“…Furthermore, tungsten, a radiopaque substance, was added so that correct intradiscal placement as well as determination of any leak could be seen under fluoroscopy at the time of placement (Figure 4). 47 In a recent Bellini et al study of 80 patients with cervical and lumbar disc herniations, 85% of those with lumbar herniations and 83% with cervical herniations benefited from intradiscal gelified ethanol, with reported pain reduction of at least 40% 48. Another study of 42 patients who failed conservative treatments and underwent intradiscal ethanol gel injection found a decrease in pain intensity by 44% and 62.6% after 1 and 3 months, respectively, versus baseline ( P =0.007) 49.…”

Section: Introductionmentioning

confidence: 99%

Treatment of chronic low back pain – new approaches on the horizon

Knežević¹,

Mandalia²,

Raasch³

et al. 2017

JPR

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Back pain is the second leading cause of disability among American adults and is currently treated either with conservative therapy or interventional pain procedures. However, the question that remains is whether we, as physicians, have adequate therapeutic options to offer to the patients who suffer from chronic low back pain but fail both conservative therapy and interventional pain procedures before they consider surgical options such as discectomy, disc arthroplasty, or spinal fusion. The purpose of this article is to review the potential novel therapies that are on the horizon for the treatment of chronic low back pain. We discuss medications that are currently in use through different phases of clinical trials (I–III) for the treatment of low back pain. In this review, we discuss revisiting the concept of chemonucleolysis using chymopapain, as the first drug in an intradiscal injection to reduce herniated disc size, and newer intradiscal therapies, including collagenase, chondroitinase, matrix metalloproteinases, and ethanol gel. We also review an intravenous glial cell-derived neurotrophic growth factor called artemin, which may repair sensory nerves compressed by herniated discs. Another new drug in development for low back pain without radiculopathy is a subcutaneous monoclonal antibody acting as nerve growth factor called tanezumab. Finally, we discuss how platelet-rich plasma and stem cells are being studied for the treatment of low back pain. We believe that with these new therapeutic options, we can bridge the current gap between conservative/interventional procedures and surgeries in patients with chronic back pain.

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Section: Introductionmentioning

confidence: 99%

Treatment of chronic low back pain – new approaches on the horizon

Knežević¹,

Mandalia²,

Raasch³

et al. 2017

JPR

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“…Radiopaque treatment was a trial only with 80 patients and reported a treatment success of 75%. A success very similar of us [20]. MB injection into the nucleus pulposus…”

Section: Discussionmentioning

confidence: 62%

Effectiveness of Three Treatment Strategies on Quality of Life for Patients with Chronic Low Back Pain: A Multidisciplinary Approach as Key to Success

Eloy¹,

Patricia²,

Gustavo³

et al. 2019

J Musculoskelet Disord Treat

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Background: Low back pain (LBP) is one of the highest prevalence problems of public health. LBP affects up to 85% people worldwide. Somebody will be affected at less in one point of his life. LBP represent an enormous economic burden on society; its total cost includes: Direct medical costs, work absenteeism, insurance, lost production and disability benefits. Current treatments range from bed rest, physiotherapy, oral analgesic, muscle relaxants, injection of corticosteroids, local anesthetic, surgery, cell based therapies aiming repair a herniated intervertebral disc and an emerging technique which use injectable hydrogels to restore disc height and function. Objective: It was to show treatment methodology, its accuracy and health satisfaction in patients who developed LBP. Methods: 1,000 patients were subject to a treatment which consists of a combination of three therapies: Physic therapy, ozone and intravenous injections. Results: This method achieves decreases 4 points in a visual analogic scale (VAS) over 12 weeks without medication. It has a rate success of 73%. This methodology may be an applicable and useful tool to avoid the surgery in those patients who present an episode of LBP. Conclusions: Randomized comparative trials are needed to further evaluate if our treatment is superior to lumbar disc surgery.

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“…In CDH, Theron et al (10) showed improved experience in 89.5% of 57 patients for RGE, without complications. Bellini et al (18) described significant symptom improvement in 6 of 7 (83%) patients, without clinical side effects. Our experience with RGE at the cervical level has shown very promising results for the treatment of CDH, with improved symptoms in 82% of patients, similar to those published.…”

Section: Discussionmentioning

confidence: 96%

“…Bellini and colleagues (18) evaluated ODI and VAS scores in 80 patients with 9 CDHs, but did not distinguish the results for the lumbar or cervical region and did not evaluate the neuropathic pattern of pain. For this reason, we cannot evaluate the results of this study with those of our own study in the same direction.…”

Section: Discussionmentioning

confidence: 99%

Long-term Clinical Effects of DiscoGel for Cervical Disc Herniation

et al. 2018

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Background: Radiopaque gelified ethanol (RGE; DiscoGel®, Gelscom SAS, France) is used as a chemonucleolysis substance in treating intradiscal herniation, showing good results without complications. It has also been used in cervical disc herniations (CDHs), demonstrating the potential efficacy of this substance. Objective: The aim of the study is to investigate the long-term effectiveness and safety of DiscoGel® in patients with CDH and chronic neck pain. Study Design: This is a cross-sectional, single-center study. Setting: The study was conducted from November 2013 to May 2016 on patients visiting Sakarya University Training and Research Hospital’s pain clinic . Methods: Each patient was evaluated before the procedure (baseline) and at 1, 3, 6, and 12 months after the procedure, using the visual analog scale (VAS) score for pain, the Oswestry Disability Index score to measure degree of disability, and estimate quality of life for those with pain; this coincides with scores on the Neuropathic Pain Questionnaire (DN4) for differential diagnoses. Results: Thirty-three patients with CDH underwent the same treatment with DiscoGel® between November 2013 and May 2016. Significant pain relief was noted, as opposed to preoperative pain, at 1, 3, 6, and 12 months after the procedure according to each patient’s self-evaluation (P = 0.01). Differences in VAS, ODI, and DN4 scores between 1, 3, 6, and 12 months with the same variables were not statistically significant. There were no complications with the procedure. Limitations: Our study was conducted retrospectively, which led to problems with long-term follow-up data. In addition, this study was performed with a small group of patients. Conclusions: RGE is a potential alternative to surgery for patients with pain at the cervical level. However, we concluded that more studies with longer follow-up intervals with RGE will be necessary for assessment of the technique’s efficiency. Key words: Cervical pain, herniation, neuropathic pain, injection, DiscoGel®, chemonucleolysis

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

Cited by 27 publications

References 14 publications

Treatment of chronic low back pain – new approaches on the horizon

Treatment of chronic low back pain – new approaches on the horizon

Effectiveness of Three Treatment Strategies on Quality of Life for Patients with Chronic Low Back Pain: A Multidisciplinary Approach as Key to Success

Long-term Clinical Effects of DiscoGel for Cervical Disc Herniation

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

Cited by 27 publications

References 14 publications

Treatment of chronic low back pain &ndash;&nbsp;new approaches on the horizon

Treatment of chronic low back pain &ndash;&nbsp;new approaches on the horizon

Effectiveness of Three Treatment Strategies on Quality of Life for Patients with Chronic Low Back Pain: A Multidisciplinary Approach as Key to Success

Long-term Clinical Effects of DiscoGel for Cervical Disc Herniation

Contact Info

Product

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Treatment of chronic low back pain – new approaches on the horizon

Treatment of chronic low back pain – new approaches on the horizon