1. 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

2. 80-90% world population: backpain
Disc hernia/Developed countries:
20% sick leave
50% early retirement

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

4. ractures of a herniated disc into the disc allowing the distribution of DISCOGEL and therefore its operation
fractures of a herniated disc allowing the distribution of DISCOGEL

5. Patient objectifs
Not more pain
Not more drugs
Sport

6. 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
The muscular atrophy is specially important in young patients

7. roser

8. 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
We dont treat patientes with previou surgery.

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

10. 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

11. 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

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

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

14. Follow up . If pain still +++:
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: , 2007

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

16. Fev 2008-June 2010 84 patiens -TOTAL LEVELS TREATED: 178
- LEVELS/PATIENT:
Cervical Dorsal Lumbar
4 or

17. Fev 2008-June 2010 84 patiens clinical symptoms Cervical Dorsal Lumbar
spine pain(SP)
SP+Uni radicul
SP+Bi-radicul
Only radiculalgia
others
Gait disturbance. Los 3 en foraminal hernia: now i undestang in these cases is essential a good filling of the hernia with discogel

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

19. 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

20. Cervical(12 patients) (fev 08-juin 10)
Before treatment 1 2 3 4 5 6 7 8 9 10  3  4  5
3 Months 1 2 3 4 5 6 7 8 9 10  1  6  3 1 
6 months 1 2 3 4 5 6 7 8 9 10 3   3  1
 1 *
three months almost all patients are placed under four . One year after the trend is zero
12 months 1 2 3 4 5 6 7 8 9 10 1*

21. 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++

22. Lumbar(71 patients) (fev 08-juin 10)
Before treatement 1 2 3 4 5 6 7 8 9 10  2
 23
 40
3 Months 1 2 3 4 5 6 7 8 9 10 5  11
 25
17 
12  1 
6 months 1 2 3 4 5 6 7 8 9 10 12
 17 11 4 
 2*
2 *
But in lumbar spine You can see, it is a six montThe when almost all patients are placed under four.But One year after the trend is too zero. At six months there are 4 worsened patients: the MRI showed persistent hernia in 3 cases : We are retreated with Discogel these 3 patients. At 12 monthsthe patients grade 4: two retreatement and one liposuctionThe patient four is treated
12 months 1 2 3 4 5 6 7 8 9 10 21 12 11  2 3* 1 

23. 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

24. CT AFTER RE-TREATMENT

25. 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. 

26. 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

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