Korean J Pain.  2020 Jan;33(1):66-72. 10.3344/kjp.2020.33.1.66.

Effectiveness of intradiscal injection of radiopaque gelified ethanol (DiscoGel^® ) versus percutaneous laser disc decompression in patients with chronic radicular low back pain

• Hashemi M
• Dadkhah P
• Taheri M
• Katibeh P
• Asadi S

• KMID: 2506645
• DOI: http://doi.org/10.3344/kjp.2020.33.1.66

Abstract

Background
Low back pain secondary to discopathy is a common pain disorder. Multiple minimally invasive therapeutic modalities have been proposed; however, to date no study has compared percutaneous laser disc decompression (PLDD) with intradiscal injection of radiopaque gelified ethanol (DiscoGel^® ). We are introducing the first study on patient-reported outcomes of DiscoGel^® vs. PLDD for radiculopathy.
Methods
Seventy-two patients were randomly selected from either a previous strategy of PLDD or DiscoGel^® , which had been performed in our center during 2016-2017. Participants were asked about their numeric rating scale (NRS) scores, Oswestry disability index (ODI) scores, and progression to secondary treatment.
Results
The mean NRS scores in the total cohort before intervention was 8.0, and was reduced to 4.3 in the DiscoGel^® group and 4.2 in the PLDD group after 12 months, which was statistically significant. The mean ODI score before intervention was 81.25% which was reduced to 41.14% in the DiscoGel^® group and 52.86% in the PLDD group after 12 months, which was statistically significant. Between-group comparison of NRS scores after two follow-ups were not statistically different (P = 0.62) but the ODI score in DiscoGel^® was statistically lower (P = 0.001). Six cases (16.67%) from each group reported undergoing surgery after the follow-up period which was not statistically different.
Conclusions
Both techniques were equivalent in pain reduction but DiscoGel^® had a greater effect on decreasing disability after 12 months, although the rate of progression to secondary treatments and/or surgery was almost equal in the two groups.

Keyword

Chronic Pain; Disability Evaluation; Discectomy; Intervertebral Disc; Low Back Pain; Pain Management; Radiculopathy; Visual Analog Scale

Figure

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  Fig. 1 Comparison of numeric rating scale (NRS) scores between two groups in different time points (P = 0.62). PLDD: percutaneous laser disc decompression, DiscoGel®: radiopaque gelified ethanol.

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  Fig. 2 Comparison of Oswestry disability index (ODI) between two groups in different time points (P = 0.001). PLDD: percutaneous laser disc decompression, DiscoGel®: radiopaque gelified ethanol.

Reference

1. Govind J. Lumbar radicular pain. Aust Fam Physician. 2004; 33:409–12. PMID: 15253601.

2. Rhee JM, Schaufele M, Abdu WA. Radiculopathy and the herniated lumbar disc. Controversies regarding pathophysiology and management. J Bone Joint Surg Am. 2006; 88:2070–80. DOI: 10.2106/00004623-200609000-00023. PMID: 17036418.

3. Wheeler AH, Murrey DB. Chronic lumbar spine and radicular pain: pathophysiology and treatment. Curr Pain Headache Rep. 2002; 6:97–105. DOI: 10.1007/s11916-002-0005-x. PMID: 11872180.

4. Buenaventura RM, Datta S, Abdi S, Smith HS. Systematic review of therapeutic lumbar transforaminal epidural steroid injections. Pain Physician. 2009; 12:233–51. PMID: 19165306.

5. Hahne AJ, Ford JJ, McMeeken JM. Conservative management of lumbar disc herniation with associated radiculopathy: a systematic review. Spine (Phila Pa 1976). 2010; 35:E488–504. DOI: 10.1097/BRS.0b013e3181cc3f56. PMID: 20421859.

6. Menchetti PPM, Bini W. Percutaneous treatment in lumbar disc herniation. Minimally invasive surgery of the lumbar spine. Menchetti PPM, editor. London: Springer;2014. p. 83–105. DOI: 10.1007/978-1-4471-5280-4_4.

7. Skovrlj B, Gilligan J, Cutler HS, Qureshi SA. Minimally invasive procedures on the lumbar spine. World J Clin Cases. 2015; 3:1–9. DOI: 10.12998/wjcc.v3.i1.1. PMID: 25610845. PMCID: 4295214.

8. Ren L, Guo H, Zhang T, Han Z, Zhang L, Zeng Y. Efficacy evaluation of percutaneous laser disc decompression in the treatment of lumbar disc herniation. Photomed Laser Surg. 2013; 31:174–8. DOI: 10.1089/pho.2012.3402. PMID: 23565889.

9. Singh V, Manchikanti L, Calodney AK, Staats PS, Falco FJ, Caraway DL, et al. Percutaneous lumbar laser disc decompression: an update of current evidence. Pain Physician. 2013; 16(2 Suppl):SE229–60. PMID: 23615885.

10. Sobieraj A, Maksymowicz W, Barczewska M, Konopielko M, Mazur D. Early results of percutaneous laser disc decompression (PLDD) as a treatment of discopathic lumbar pain. Ortop Traumatol Rehabil. 2004; 6:264–9.

11. Guarnieri G, De Dominicis G, Muto M. Intradiscal and intramuscular injection of Discogel^®—radiopaque gelified ethanol: pathological evaluation. Neuroradiol J. 2010; 23:249–52. DOI: 10.1177/197140091002300216. PMID: 24148546.

12. Léglise A, Lombard J, Moufid A. DiscoGel^® in patients with discal lumbosciatica. Retrospective results in 25 consecutive patients. Orthop Traumatol Surg Res. 2015; 101:623–6. DOI: 10.1016/j.otsr.2015.05.007. PMID: 26215088.

13. Volpentesta G, De Rose M, Bosco D, Stroscio C, Guzzi G, Bombardieri C, et al. Lumbar percutaneous intradiscal injection of radiopaque gelified ethanol (“Discogel”) in patients with low back and radicular pain. J Pain Relief. 2014; 3:145. DOI: 10.4172/2167-0846.1000145.

14. Haefeli M, Elfering A. Pain assessment. Eur Spine J. 2006; 15(Suppl 1):S17–24. DOI: 10.1007/s00586-005-1044-x. PMID: 16320034. PMCID: 3454549.

15. Fairbank JC, Pynsent PB. The Oswestry disability index. Spine (Phila Pa 1976). 2000; 25:2940–52. DOI: 10.1097/00007632-200011150-00017. PMID: 11074683.

16. Zhao XL, Fu ZJ, Xu YG, Zhao XJ, Song WG, Zheng H. Treatment of lumbar intervertebral disc herniation using C-arm fluoroscopy guided target percutaneous laser disc decompression. Photomed Laser Surg. 2012; 30:92–5. DOI: 10.1089/pho.2011.3050. PMID: 22150064. PMCID: 3270046.

17. Knezevic NN, Mandalia S, Raasch J, Knezevic I, Candido KD. Treatment of chronic low back pain - new approaches on the horizon. J Pain Res. 2017; 10:1111–23. DOI: 10.2147/JPR.S132769. PMID: 28546769. PMCID: 5436786.

18. Epstein NE. Should anyone perform percutaneous endoscopic laser diskectomy and percutaneous lumbar disc decompressions? Surg Neurol Int. 2016; 7(Suppl 42):S1080–4. DOI: 10.4103/2152-7806.196764. PMID: 28144489. PMCID: 5234304.

19. Ishiwata Y, Takada H, Gondo G, Osano S, Hashimoto T, Yamamoto I. Magnetic resonance-guided percutaneous laser disk decompression for lumbar disk herniation--relationship between clinical results and location of needle tip. Surg Neurol. 2007; 68:159–63. DOI: 10.1016/j.surneu.2006.10.058. PMID: 17662349.

20. Haufe SM, Mork AR, Pyne M, Baker RA. Percutaneous laser disc decompression for thoracic disc disease: report of 10 cases. Int J Med Sci. 2010; 7:155–9. DOI: 10.7150/ijms.7.155. PMID: 20567616. PMCID: 2880844.

21. Lee DY, Lee SH. Carbon dioxide (CO2) laser-assisted microdiscectomy for extraforaminal lumbar disc herniation at the L5-S1 level. Photomed Laser Surg. 2011; 29:531–5. DOI: 10.1089/pho.2010.2954. PMID: 21309702.

22. Ren L, Guo B, Zhang T, Bai Q, Wang XH, Zhang L, et al. Medium-term follow-up findings in imaging manifestation after percutaneous laser disc decompression. Photomed Laser Surg. 2013; 31:247–51. DOI: 10.1089/pho.2012.3433. PMID: 23741993.

23. Hashemi SM, Dadkhah P, Taheri M, Abootorabi SMHS. Effects of percutaneous laser disc decompression (PLDD) on clinical outcome of teared vs intact protruded intervertebral discs: a prospective cohort study. 2018; 2:279–85.

24. Brouwer PA, Brand R, van den Akker-van Marle ME, Jacobs WC, Schenk B, van den Berg-Huijsmans AA, et al. Percutaneous laser disc decompression versus conventional microdiscectomy in sciatica: a randomized controlled trial. Spine J. 2015; 15:857–65. DOI: 10.1016/j.spinee.2015.01.020. PMID: 25614151.

25. Asgharzadeh A, Khoshnood N. Evaluating the safety and efficacy of discogel in the treatment of herniated lumbar disc: a systematic review. Health Tech Asmnt Act. 2017; 1:e62329. DOI: 10.5812/htaa.62329.

26. Theron J, Cuellar H, Sola T, Guimaraens L, Casasco A, Courtheoux P. Percutaneous treatment of cervical disk hernias using gelified ethanol. AJNR Am J Neuroradiol. 2010; 31:1454–6. DOI: 10.3174/ajnr.A1923. PMID: 20053805.

27. Theron J, Guimaraens L, Casasco A, Sola T, Cuellar H, Courtheoux P. Percutaneous treatment of lumbar intervertebral disk hernias with radiopaque gelified ethanol: a preliminary study. J Spinal Disord Tech. 2007; 20:526–32. DOI: 10.1097/BSD.0b013e318033e860. PMID: 17912130.

28. Bellini M, Romano DG, Leonini S, Grazzini I, Tabano C, Ferrara M, et al. Percutaneous injection of radiopaque gelified ethanol for the treatment of lumbar and cervical intervertebral disk herniations: experience and clinical outcome in 80 patients. AJNR Am J Neuroradiol. 2015; 36:600–5. DOI: 10.3174/ajnr.A4166. PMID: 25395657.

29. Klessinger S. The frequency of resurgery after percutaneous lumbar surgery using dekompressor in a ten-year period. Minim Invasive Surg. 2018; 2018:5286760. DOI: 10.1155/2018/5286760. PMID: 30402284. PMCID: 6198552.

30. Zamora T, Palma J, Andia M, Garcia P, Wozniak A, Solar A, et al. Effect of propionibacterium acnes (PA) injection on intervertebral disc degeneration in a rat model: does it mimic modic changes? Orthop Traumatol Surg Res. 2017; 103:795–9. DOI: 10.1016/j.otsr.2017.04.005. PMID: 28552835.

31. Rao PJ, Phan K, Reddy R, Scherman DB, Taylor P, Mobbs RJ. DISC (degenerate-disc infection study with contaminant control): pilot study of Australian cohort of patients without the contaminant control. Spine (Phila Pa 1976). 2016; 41:935–9. DOI: 10.1097/BRS.0000000000001404. PMID: 26679882.

32. Chen Z, Zheng Y, Yuan Y, Jiao Y, Xiao J, Zhou Z, et al. Modic changes and disc degeneration caused by inoculation of propionibacterium acnes inside intervertebral discs of rabbits: a pilot study. Biomed Res Int. 2016; 2016:9612437. DOI: 10.1155/2016/9612437. PMID: 26925420. PMCID: 4746301.