Intradiscal Gelified Ethanol Nucleolysis versus Endoscopic Surgery for Lumbar Disc Herniation Radiculopathy

Abstract

The purpose of this study was to retrospectively compare efficacy and safety between intradiscal injection of a gelified ethanol product and tubular discectomy in the treatment of intervertebral disk herniation. A bi-central institutional database research identified forty (40) patients suffering from symptomatic contained disc herniation. Nucleolysis Group included 20 patients [mean 50.05 ± 9.27 years-of-age (male/female 14/6-70/30%)] and Surgery Group included 20 patients [mean 48.45 ± 14.53 years-of-age, (male/female 12/8-60/40%)]. Primary outcome was overall 12-month improvement over baseline in leg pain (NVS units). Procedural technical outcomes were recorded, and adverse events were evaluated at all follow-up intervals. CIRSE classification system was used for complications' reporting. Mean pre-operative pain score in Nucleolysis Group was 7.95 ± 0.94 reduced to 1.25 ± 1.11 at month 1 and 0.45 ± 0.75 NVS units at year 1. Mean pre-operative pain score in Surgery Group was 7.65 ± 1.13 reduced to 1.55 ± 1.79 at month 1 and 0.70 ± 1.38 NVS units at year 1. Pain decrease was statistically significant after both procedures (p < 0.001). There was no statistically significant difference between pain reduction in both groups (p = 0.347). The decrease differences of the pain effect upon general activities, sleeping, socializing, walking, and enjoying life in the follow-up period between the two groups were not statistically significant. No complications were noted in both groups. Results from the current study report that intradiscal injection of a gelified ethanol and tubular discectomy were equally effective on terms of efficacy and safety for the treatment of symptomatic lumbar intervertebral disc herniation regarding the 12-month mean leg pain improvement. Both achieved similar rapid significant clinical improvement persisting throughout follow-up period.

Keywords: alcohol; herniation; injection; intervertebral disc; pain; tubular discectomy.

Figure 1

(A) A-P fluoroscopy view during needle placement in intradiscal Discogel injection for the treatment of an L4–L5 intervertebral disc herniation. Final position of the needle should in A-P projection in the midline between the two end plates. (B) Lateral fluoroscopy view during needle placement in intradiscal Discogel injection for the treatment of an L4–L5 intervertebral disc herniation. Final position of the needle should be to towards the anterior third of the intervertebral disc between the two end plates. (C) Lateral fluoroscopy view post intradiscal Discogel injection for the treatment of an L4–L5 intervertebral disc herniation. Discogel can be seen as radio-opaque material inside the disc.

Figure 2

Axial and sagittal CT reconstructions performed immediately post RGE injection aiming to evaluate distribution of the product (black arrows) and rule out any potential extradiscal leakages.

Figure 3

Tubular discectomy of L4–L5 intervertebral disc herniation. Both the introduction tube of the endoscope (at the surgeon’s left hand) as well as the long disc forceps for the removal of the disc fragments (at the right hand of the surgeon) are visible.

Figure 4

Estimated marginal means of pain scores. 1: baseline, 2: 1 month follow-up period, 3: 12 months follow-up period.

Figure 5

Estimated marginal means of pain decrease and its effect upon general activities, sleeping, walking, socializing, and enjoying life. 1: baseline, 2: 1 month follow-up period, 3: 12 months follow-up period.