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

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

Patient objectifs Not more pain Not more drugs Sport

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

roser

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 treatement: systemic antibiotic and antinflamatory

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

PROCEDURE III Lumbar: 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 anti- inflammatory 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 treatement).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: , 2007

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

Fev 2008-June patiens -TOTAL LEVELS TREATED: LEVELS/PATIENT: Cervical Dorsal Lumbar or + 2

Fev 2008-June patiens clinical symptoms Cervical Dorsal Lumbar spine pain(SP) 6 SP+Uni radicul SP+Bi-radicul 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 treatement months * 3 Months months *1*

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

Lumbar(71 patients) (fev 08-juin 10) Before treatment months * 3 Months months *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-TREATEMENT

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

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