HERNIATED DISK: TREATMENT PERCUTANEOUS USING DISCOGEL

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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

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

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percutaneous treatment of hernial disk
Psicological factors
disk
muscles
articular
Feets
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(No Transcript)
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Patient objectifs

• Not more pain
• Not more drugs
• Sport

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• 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

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roser
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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

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PROCEDURE

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

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PROCEDURE II

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

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PROCEDURE III

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

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PROCEDURE IV

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

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POSTPROCEDURE

• CT Discogel distribution
• 1 night in hospital( control patient)
• Discharge therapy tapered anti-inflammatory
  regimen (10 days)

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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

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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

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Fev 2008-June 201084 patiens

• -TOTAL LEVELS TREATED 178
• - LEVELS/PATIENT
• Cervical Dorsal
  Lumbar
• 1 2 1
  13
• 2 6
  38
• 3 4
  18
• 4 or
  2

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Fev 2008-June 201084 patiens

• clinical symptoms
• Cervical
  Dorsal Lumbar
• spine pain(SP)
  6
• SPUni radicul. 8
  47
• SPBi-radicul. 3 1
  15
• Only radiculalgia
  3
  
• others 1
  

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COMPLICATIONS

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

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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

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Cervical(12 patients)(fev 08-juin 10)
Before treatment Before treatment Before treatment Before treatment Before treatment Before treatment Before treatment Before treatment Before treatment Before treatment Before treatment
0 1 2 3 4 5 6 7 8 9 10
             3  4  5
3 Months 3 Months 3 Months 3 Months 3 Months 3 Months 3 Months 3 Months 3 Months 3 Months 3 Months
0 1 2 3 4 5 6 7 8 9 10
 1    6  3 1  1       
6 months 6 months 6 months 6 months 6 months 6 months 6 months 6 months 6 months 6 months 6 months
0 1 2 3 4 5 6 7 8 9 10
3 3   3  1  1          
12 months 12 months 12 months 12 months 12 months 12 months 12 months 12 months 12 months 12 months 12 months
0 1 2 3 4 5 6 7 8 9 10
4 1 1            
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Follow up(CERVICAL12 patients)

• - Re-treatment 0 cases
• -1 case cervical to surgery(6 months)
• arthrosis
• - 1 patient grade 2 at 12 months
• TMA arthrosis

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Lumbar(71 patients)(fev 08-juin 10)
Before treatement Before treatement Before treatement Before treatement Before treatement Before treatement Before treatement Before treatement Before treatement Before treatement Before treatement
0 1 2 3 4 5 6 7 8 9 10
             2  23  40 6
3 Months 3 Months 3 Months 3 Months 3 Months 3 Months 3 Months 3 Months 3 Months 3 Months 3 Months
0 1 2 3 4 5 6 7 8 9 10
  5  11  25 17  12    1   
6 months 6 months 6 months 6 months 6 months 6 months 6 months 6 months 6 months 6 months 6 months
0 1 2 3 4 5 6 7 8 9 10
1 12  17  17 11 4   2 2     
12 months 12 months 12 months 12 months 12 months 12 months 12 months 12 months 12 months 12 months 12 months
0 1 2 3 4 5 6 7 8 9 10
21 12 11  2 3   1       
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Follow up(LUMBAR71 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

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CT AFTER RE-TREATMENT
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ANALYSIS RESULTSCERVICAL 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. 

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• 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

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percutaneous treatement of hernial disk
Psicological factors
disk
muscles
articular
Feets