Devoted to diagnostic and interventional spine imaging and therapeutics

Library

Percutaneous treatment of cervical and thoracic intervertebral hernias with radiopaque gelified ethanol 2008

Interventional Spine

Jacques Theron, MD,
Leopoldo Guimaraens, MD, Non ASSR Member
Alfredo Casasco, MD, Non ASSR Member
Teresa Sola, MD, Non ASSR Member
Hugo Cuellar, MD, Non ASSR Member
Patrick Courtheoux, MD, Non ASSR Member

Scientific Paper

Purpose

Pure Ethanol has been shown to be efficient in the treatment of disk hernias (1). Nevertheless its use in cervical , thoracic hernias and in hernias with epidural leak at discography appears relatively risky because of the difficulty in limiting its diffusion. We present here a complement of the pilot study dealing with lumbar hernias (2).
The addition of ethylcellulose to ethanol results in a viscous product that nevertheless is injectable.In order to precisely determine the site of the injection an inert metallic powder was added to the product .

Methods & Materials

55 cervical and 4 thoracic hernias have been treated. All the procedures have been performed on an out patient basis on local anesthesy or light sedation. 0.2 to 0.3 cc have been injected in the center of the diskin cervical hernias and 0.3 to 0.4 cc in thoracic hernias. In cervical hernias a complementary injection has been performed in the adjacent facet joints. A CT has been systematically performed after the procedure to map the exact location of the radiopaque gel.

Results

There has been no complication. In cervical hernias, the results have been very good in 11 cases, good in 38 cases (VG + G 49, 89%), fair in 5 cases, bad in one case (no open surgery). In thoracic hernias the results have been very good in 1 case, good in 2 cases, faifrin 1 case (no open surgery. On the post treatment CT, it appeared that the gel follows the zones of fragility of the disc and in particular the intradiscal fissures. In the excluded hernias it was usual, but not constant, to see the gel penetrating and concentrating into the excluded fragment.

Conclusion

This pilot study has shown that the efficacy of this new medical device is comparable to Chymopapain in the treatment of disk hernias. It has also shown its immediate and long term safety.

References

1)Riquelme C, Musacchio M, Mont'alverne F, Tournade A. Chemonucleolysis of lumbar disc herniation with ethanol. J.Neuroradiol.2001,28,219-229
2)Theron J, Guimaraens L, Casasco A, Sola T, Cuellar H, Courtheoux P."Percutaneous treatment of lumbar intervertebral disk hernias with radiopaque gelified ethanol"J Spinal Didord, volume 20, number 7, oct. 2007, p526-532.
Jacques Theron, consultant Gelscom (Discogel).

Images

[gallery]