Percutaneous intradiscal injection of radiopaque gelified ethanol: short- and long-term functional outcome and complication rate in a consecutive series of patients with lumbar disc herniation

Abstract

Lumbar disc herniation (LDH) is a common cause of low back pain (LBP) and/or radicular pain (RP). Over the years, different therapies have been proposed to treat symptomatic LDH, including different minimally invasive techniques and open surgical methods. Recently, percutaneous intradiscal injection of radiopaque gelified ethanol (RGE) DiscoGel® has emerged as an effective therapeutic option in patients with LDH. Nevertheless, only few studies addressed the reliability of this technique. The purpose of this study was to evaluate the efficacy and safety of this procedure. We analysed surgical and outcome data of patients with small or medium LDH treated by DiscoGel between 2012 to 2015. Outcome variables included pain relief, the limitation on physical activity and severity of depression status. Overall, complication rate was defined as the occurrence of any perioperative adverse events. A total of 94 consecutive patients were enrolled in the study. Pain relief was achieved in 90.6% and 88.8% of patients at 1- and 4-year follow-up, respectively. At the last follow-up, at least a satisfactory result was achieved in 92.5% of patients. Similar results were obtained in the limitation on physical activity. Depression status did not significantly change after treatment. There was no mortality, and no patients experienced permanent sequelae. In well-selected patients, DiscoGel has proved effective in maintaining excellent functional results in terms of pain relief and limitation on physical activity while minimizing the overall rate of complications related to these kinds of surgical procedures.

Efficacy of DiscoGel in Treatment of Degenerative Disc Disease: A Prospective 1-Year Observation of 67 Patients

“…The preliminary results have rekindled the interest in chemonucleolysis, which was abandoned about the turn of the century. In the ensuing years, several studies corroborated the ethanol gel efficacy in the treatment of radicular pain, sciatica, and disc hernias [ 28 , 29 , 30 , 31 , 32 ]. We are aware of only two papers on GEI in patients with lumbar DP [ 34 , 35 ].…”

“…Ethanol gel is easy to handle, and the presence of radiopaque tungsten facilitates injection monitoring. Several studies demonstrated the efficacy and safety of gelified ethanol injection (GEI) [ 28 , 29 , 30 , 31 , 32 ]. Please note that in the literature this procedure is also referred to as ethanol gel chemonucleolysis.…”

Intradiscal Therapies for Lumbar Degenerative Disk Disease

“…La Torre et al 20 demonstrated DiscoGel efficacy in a retrospective cohort, showing a reduction in VAS pain from 8.4 ± 1.04 to 2.8 ± 1.07 ( P < 0.05) and an increase in Short Form-36 from 27.2 ± 12.21 to 74.3 ± 13.31 ( P < 0.05) at 1-month follow-up that was sustained at a final mean follow-up of 44 months. At final follow-up, 92.5% of patients had VAS improvement >50%, with only four patients requiring open surgery for persistent severe pain.…”

“…DiscoGel is a sterile viscous solution composed of gelified ethanol in a tungsten particle suspension. 20 The solution is injected into the NP to fill radial fissures with new gelatinous material. The hypothetical mechanisms of action are reducing intradiscal pressure by osmotic dehydration of the nucleus, resulting in decompression of the offended nerve roots as well as denaturation of nociceptive nerve endings in the degenerated disk.…”

“…La Torre et al 20 Although originally designed for disk herniation, DiscoGel has been used for chronic discogenic pain as well. Papadopoulos et al 22 ran a small RCT comparing DiscoGel alone versus DiscoGel plus pulsed RF.…”