Journal de la douleur et du soulagement

Abstrait

Lumbar Percutaneous Intradiscal Injection of Radiopaque Gelified Ethanol (Discogel) in Patients with Low Back and Radicular Pain

Volpentesta G, De Rose M, Bosco D, Stroscio C, Guzzi G, Bombardieri C, Chirchiglia D, Plastino M, Romano M, Cristofalo S, Pardatscher K and Lavano A*

Partial removal of nucleus pulposus with consequent reduction of intradiscal pressure may be obtained with percutaneous intradiscal administration of chemical substances in the intervertebral disc. We used percutaneous intradiscal injection of radiopaque gelified ethanol (“Discogel”) in 72 patients (group 1) with conservative treatment resistant lumbar and radicular pain due to small and medium-size hernias of intervertebral disc to demonstrate its efficacy and safety vs. 72 subjects treated with intra-foraminal and intradiscal injections of a steroid and anesthetic (group 2 or control group). “Discogel” injection was performed with biplane fluoroscopy assistance and under local anesthesia with patient in lateral position on symptomatic side. Amount of “Discogel” injected ranged from 0.8 ml to 1.6 ml. We treated a total of 83 discs. We performed the procedure on one disc in 62 patients; in 9 patients two discs were treated in the same session and in 1 patient three levels were treated in two separate sessions. In group 1 patient “responders” were 65 (90.3%). Excellent and good results were obtained in 58 patients (80.4%), satisfactory results in 7 patients (9.8%) and poor results in 7 patients (9.8%); among “responders” pain control was quite immediate in 58 patients (89.3%) while in 7 patients (10.7%) there was a delay of 7-10 days. These values were significantly higher than in control group. Also the quality of life was significantly more sustained vs. control group, and this benefit was maintained over time. Concerning complications, in 3 cases (4.15%) we had transitory radicular irritation with neuropathic pain appearance immediately after the procedure and in 1 case (1.30%) transitory sensory-motor deficit due to diffusion of local anesthetic along the introducer needle. In conclusion intradiscal radiopaque gelified ethanol injection is minimally invasive, low cost, safe and effective procedure that may be considered in proper selected patients before recourse to surgery.