herniated disk: treatment percutaneous using discogel

HERNIATED DISK: TREATMENT
PERCUTANEOUS USING
DISCOGEL®
T. Sola, Theron J, Diaz C, Vivas E,Cuellar H, Guimaraens L
Servicio de Neuroangiografía
Hospital General de Cataluña. Barcelona. Spain

• 80-90% world population: backpain
• Disc hernia/Developed countries:
20% sick leave
50% early retirement

“percutaneous treatment of hernial disk”
Psicological factors
Feets
muscles
articular
disk
nerve

• Not more pain
• Not more drugs
• Sport
Patient objectifs

• Herniated disk: clinical problem
• Objectif: pain treatment
• Disc hernia: consequence of
dysfonctionement of paraspinal muscles
• Radiological objectif: disparition of hernia
(almost always after clinical amelioration)
• We dont treat patients with previous
surgery

oser

Pre-procedure
¤ Patients selection :
- artrhosis+++ - CT : valoration of
discal compresion
- symptoms+++ - Electromyogram: to
determine the degree of urgence
¤ Planification:
- clinical symptoms
- MRI: determine the levels to treat
- correlation pain/radiological findings

PROCEDURE
• Biplanar angyographe
• Lumbar and dorsal: neuroleptoanalgesia
• Cervical: general anestesia( patient
confort)
• Medical treatment: systemic antibiotic and
antinflamatory

PROCEDURE II
• Lumbar: decubitus left lateral(left post-lat)
• Dorsal: decubito prono(post-lat approach)
• Cervical: decubito supino(right Anterolateral
approach)
• Lumbar and dorsal: 20 G needle
• Cervical: 21G needle

PROCEDURE III
• Lumbar: 0.8-1.2 cc discogel/level
• Dorsal: 0.6 cc discogel/level
• Cervical: 0.4cc discogel/level
1) Needle central
2) Very slowly injection( like Onix)
3) Permanent scopia control of injection

PROCEDURE IV
Steroid intraarticular infiltration(22G)
- Dorsal /lumbar: decubito prono
- Cervical: decubito supino
*Bilateral . Same treated levels

POSTPROCEDURE
• CT: Discogel distribution
• 1 night in hospital( control patient)
• Discharge therapy: tapered antiinflammatory
regimen (10 days)

Follow up
• Consultation all the months 1 year post procedure
- paraspinal muscular stimulation seances
. If pain still +++:
. eventually re-intraarticular infiltration (3
months after treatment)
.eventually Discogel re-treatment( if MRI
confirmed the persistence of hernia) (6 months after
treatment)
. eventually Lumbosacral Liposuction
**Lumbosacral Liposuction.A New Tool for The Treatment of Low Back Pain
J.THÉRON1, L. GUIMARAENS2-3,A. CASASCO3, H. CUELLAR3, T.
SOLA2Interventional Neuroradiology 13: 153-160, 2007

Fev 2008-June 2010
• 84 patients( 38F and 46M )
• Age: 17-81 y ( 40 patients :30-50 years)
• LOCATION:
-Cervical: 12
-Dorsal: 1
-Lumbar: 71

Fev 2008-June 2010
84 patiens
-TOTAL LEVELS TREATED: 178
- LEVELS/PATIENT:
Cervical Dorsal Lumbar
• 1 2 1 13
• 2 6 38
• 3 4 18
• 4 or + 2

clinical symptoms
Fev 2008-June 2010
84 patiens
Cervical Dorsal Lumbar
• spine pain(SP) 6
• SP+Uni radicul. 8 47
• SP+Bi-radicul. 3 1 15
• Only radiculalgia 3
• others 1

COMPLICATIONS
• No case of infection
• No anaphylactic reaction
• 2 lumbar cases: radicular irritation after
treatment( for the needle)
1 month antinflammatory therapy

PAIN EVALUATION
• analysis made by patients
• The numerical rating scales (NRS):
- the patients were asked to rate their pain on
a 0 to 10
- scale where 0 indicates "No pain" and 10
"The worst possible pain”.
• Analysis before, 3 months, 6 months and 12
months after treatment
• Recovery time is proportional to pain time

Cervical(12 patients)
(fev 08-juin 10)
Before treatment
0 1 2 3 4 5 6 7 8 9 10
3 Months
6 months
3 4 5
0 1 2 3 4 5 6 7 8 9 10
1 6 3 1 1
0 1 2 3 4 5 6 7 8 9 10
3 3 3 1 1 *
12 months
0 1 2 3 4 5 6 7 8 9 10
4 1 1*

Follow up
(CERVICAL:12 patients)
- Re-treatment: 0 cases
-1 case cervical to surgery(6 months)
arthrosis+++
- 1 patient grade 2 at 12 months
TMA arthrosis++

Lumbar(71 patients)
(fev 08-juin 10)
Before treatement
0 1 2 3 4 5 6 7 8 9 10
3 Months
6 months
2 23 40 6
0 1 2 3 4 5 6 7 8 9 10
5 11 25 17 12 1
0 1 2 3 4 5 6 7 8 9 10
1 12 17 17 11 4 2* 2 *
12 months
0 1 2 3 4 5 6 7 8 9 10
21 12 11 2 3* 1

Follow up
(LUMBAR:71 patients)
- 3 patients lost
- 5 re-steroid infiltration (at 3 months)
- 6 Discogel retreatment:
- 4 at 6 months
- 2 at 12 months
- 1 lumbar liposuction : at 12 months
* 6 retreatment: good filling of the hernia

CT AFTER RE-TREATMENT

ANALYSIS RESULTS
CERVICAL versus LUMBAR
• The evaluation of these results shows that before
treatment, the NRS( Pain scale) does not different
between cervical and lumbar spine
• The degree of recovery is much faster at cervical
level. Cervical level was not needed any
retreatment
• Hypotese: the difference in weight to bear for the
cervical and lumbar spine is directly linked to the
fundamental importance of the role of paraspinal
muscles in lumbar hernias.

• Discogel is very effective for the herniated
disk((clinical and radiological)
• Herniated disk is as a locoregional problem and even a
global problem (osteoarthosis, feets problems,TMJ and
psychological factors in some cases play an important
role)
• Herniated disk : Clinical problem
• No interference to “eventually posterior” treatments
• No major complications
• Follow up: 1 year

“percutaneous treatement of hernial disk”
Psicological factors
Feets
muscles
articular
disk
nerve