Standards of Practice: Quality Assurance Guidelines for Percutaneous Treatments of Intervertebral Discs

Abstract

Percutaneous treatments are used in the therapy of small-to medium-sized hernias of intervertebral discs to reduce the intradiscal pressure in the nucleus and theoretically create space for the herniated fragment to implode inward, thus reducing pain and improving mobility and quality of life. These techniques involve the percutaneous removal of the nucleus pulposus by using a variety of chemical, thermal, or mechanical techniques and consist of removal of all or part of nucleus pulposus to induce more rapid healing of the abnormal lumbar disc. These guidelines are written to be used in quality improvement programs for assessing fluoroscopy-and/or computed tomography-guided percutaneous intervertebral disc ablative techniques.

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

“…In healthy individuals, the intact nucleus pulposus and annulus fibrosus may also act to restrict the diffusion of the injected material but movement of the material into the vertebral canal may be more likely in animals with intervertebral disc degeneration. In fact, the procedure is contraindicated in human patients with extruded intervertebral disc material due to the increased risk of leakage of material into the vertebral canal . Nevertheless, we did not find an association with the Pfirrmann grade of intervertebral disc degeneration and the rate of leakage of the material into the vertebral canal, perhaps because of the small population or the fact that most had only a low grade of disc degeneration.…”

“…The material that was seen within the vertebral canal was suspected to be within the epidural space however leakage of the material into the subdural space cannot be excluded. In human patients, complications following percutaneous intervertebral disc injections are rare with the most commonly reported being diskitis, radiculitis, and epidural abscesses . Another potential complications is discospondylitis.…”

“…In human medicine, multiple minimally invasive procedures have been evaluated for the treatment of protrusions of the intervertebral disc . These procedures include chemical, ultrasonic, laser, and thermal methods of nucleolysis, which all share the same goal of ablation of the degenerative nucleus pulposus . The aim of these techniques is to cause either a decrease in the intradiscal pressure or dehydration of the nucleus pulposus causing the herniated portion of the intervertebral disc to recede .…”

“…17,[19][20][21][22][23][24][25][26][27][28][29] These procedures include chemical, ultrasonic, laser, and thermal methods of nucleolysis, which all share the same goal of ablation of the degenerative nucleus pulposus. 28,30 The aim of these techniques is to cause either a decrease in the intradiscal pressure or dehydration of the nucleus pulposus causing the herniated portion of the intervertebral disc to recede. 28,30 Few reports have been published on minimally invasive injectable therapy for intervertebral disc herniation in dogs.…”

“…28,30 The aim of these techniques is to cause either a decrease in the intradiscal pressure or dehydration of the nucleus pulposus causing the herniated portion of the intervertebral disc to recede. 28,30 Few reports have been published on minimally invasive injectable therapy for intervertebral disc herniation in dogs. 20,[31][32][33][34] A radiopaque gelified ethanol product (Discogel, Gelscom, France) has recently been developed for Vet Radiol Ultrasound, Vol.…”