A minimally invasive treatment for lumbar disc herniation: DiscoGel® chemonucleolysis in patients unresponsive to chemonucleolysis with oxygen-ozone

Abstract

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. O₂-O₃ chemonucleolysis (O₂-O₃ 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 8,9. The present study aimed to assess the therapeutic outcome of DiscoGel® chemonucleolysis in patients with lumbar disc herniation unresponsive to O₂-O₃ therapy. 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. DiscoGel® is safe and easy to handle and there were no complications related to product diffusivity outside the treatment site. The therapeutic success rate of DiscoGel® chemonucleolysis in patients unresponsive to O₂-O₃ 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.

Figures

Figure 1

22 G × 15 cm spinal needle.

Figure 2

1 ml DiscoGel® syringe.

Figure 3

A,B) Lumbar intersomatic disc puncture under fluoroscopic guidance.

Figure 4

A,B) Right lateral approach to L1-L2 disc in a 47-year-old woman (0.8 ml DiscoGel®).

Figure 5

A,B) left lateral approach to L4-L5 and L5-S1 discs in a 40-year-old man (0.8 ml DiscoGel® × 2).

Figure 6

A,B) Right lateral approach to L5-S1 disc in a 52-year-old woman (0.7 ml DiscoGel®).