Discoplasty

Discoplasty with Discogel (Discogel chemonucleolysis)

Intervertebral disc herniation is a very common condition in adults. It is caused when a small portion of the intervertebral disc (inserted between the vertebrae) presses on the adjacent nerve, resulting in pain in the leg (sciatica) or arm. The most common treatment intervention is conservative (includes bed rest and painkillers). If conservative treatment fails, various surgical interventions are available and usually provide immediate relief.

Recently, the results of newer percutaneous techniques (discoplasty and nucleolysis) have become known from the literature in order to avoid surgery in case of persistence of the patient's symptoms (persistent pain despite conservative treatment).

One of the most modern percutaneous techniques is the chemical destruction of the intervertebral disc nucleus pulposus with discogel. Discogel is a material in liquid form (ethanol solution in gel and contrast material). The technique is simple and easily tolerated by the patient. Under local anaesthesia, a needle is inserted into the intervertebral disc under radiological guidance and discogel is injected into the disc. The procedure takes 10 minutes. The patient then remains lying down for 2 hours and is discharged from the hospital. Pain relief is not immediate but a period of a few days is allowed for the patient to get relief. With this technique it is estimated that 60% of patients with severe radicular pain in the legs due to a small herniated disc can avoid surgery. This procedure is not indicated in large herniated discs where percutaneous microdiscectomy is usually required.

The same technique is used for intradiscal electrothermal therapy (IDET). In this case, a small electrode under local anaesthesia is inserted into the intervertebral disc and the disc is thermally vaporised-absorbed by radiofrequency.

Indications for percutaneous techniques

• Intervertebral disc prolapse or protrusion (grade 1, i.e. small herniated disc)
• Discogenic pain
• Patient who does not want or is not amenable to surgery (due to coexisting problems)

Discoplasty with discogel for herniated disc 05-1 interval.