The effect of intradiscal injection of percutaneous radiopaque gel ethanol on pain in patients with lumbar disc herniation: Our clinical experience.

Yıl 2022, Cilt: 3 Sayı: 2, 130 - 137, 01.08.2022

Oğuz Gürbüz Mehmet Beşir Sürme

Öz

Introduction: Lumbar disc herniation (LDH); It is an important disease that is common in society and can cause socioeconomic problems. There are many treatment algorithms for LDH, including medical and surgical. Our aim in this study; To evaluate the clinical results of patients with LDH who did not benefit from conservative treatment after percutaneous intradiscal radiopaque gel ethanol (RGE) procedure in the light of the literature. Methods: A total of 44 levels of percutaneous intradiscal RGE were applied to 41 patients, 14 men and 27 women, hospitalized with the diagnosis of LDH. patients; Demographic characteristics, treatments they received, lumbar magnetic resonance imaging (MRI) taken 6 months later, visual analog scores (VAS) before and 6 months after percutaneous intradiscal RGE procedure, complications, side effects and patient satisfaction after the procedure were evaluated. Results: The VAS values of the patients were 8 before the procedure and 4.2 6 months after the procedure. A 47.5% reduction in pain was observed and these data were evaluated as statistically significant. When patients were asked about their satisfaction with the procedure after the percutaneous RGE procedure; 4 patients answered "poor", 13 patients "moderate", 13 patients "good" and 11 patients "excellent". The rate of those who were satisfied with the procedure was 90.2%, and these data were not considered statistically significant. Conclusion: As a result; Percutaneous intradiscal RGE procedure, in patients with a diagnosis of LDH and who did not benefit from conservative treatment; It can be a minimally invasive technique that reduces pain.

Anahtar Kelimeler

Lumbar disc herniation, Percutaneous intradiscal injection, Radiopaque gel ethanol, Visuel analog scale

Lomber disk hernisi olan hastalarda intradiskal perkütan radyoopak jel etanol enjeksiyonunun ağrı üzerine etkisi: Klinik deneyimimiz

Öz

Giriş: Lomber disk hernisi (LDH); Toplumda sık görülen ve sosyoekonomik sorunlara neden olabilen önemli bir hastalıktır. LDH için tıbbi ve cerrahi dahil olmak üzere birçok tedavi algoritması vardır. Bu çalışmadaki amacımız; konservatif tedaviden fayda görmeyen LDH'li hastaların Perkütan intradiskal radyoopak jel etanol (RGE) işlemi sonrası klinik sonuçlarını literatür ışığında değerlendirmektir. Yöntemler: LDH tanısı ile yatırılan 14'ü erkek, 27'si kadın olmak üzere 41 hastaya toplam 44 seviyede perkütan intradiskal RGE uygulandı. Hastalar; demografik özellikler, aldıkları tedaviler, 6 ay sonra çekilen lomber manyetik rezonans görüntüleme (MRG), perkütan intradiskal RGE işlemi öncesi ve 6 ay sonraki görsel analog skorlamalar(VAS), komplikasyonlar, yan etkiler ve işlem sonrası hasta memnuniyeti açısından değerlendirildi. Bulgular: Hastaların VAS değerleri işlem öncesi 8, işlemden 6 ay sonra 4.2 olarak saptandı. Ağrıda %47.5'lik bir azalma olduğu izlendi ve bu veriler istatistiksel olarak anlamlı olarak değerlendirildi. Perkütan RGE işlemi sonrası hastalara işlemden memnuniyetleri sorulduğunda; 4 hasta "kötü", 13 hasta "orta", 13 hasta "iyi" ve 11 hasta "mükemmel" yanıtını vermiştir. İşlemden memnun olanların oranı %90,2 olup bu veriler istatistiksel olarak anlamlı kabul edilmedi. Sonuç: Sonuç olarak; Perkütan intradiskal RGE işlemi, LDH tanısı olan ve konservatif tedaviden fayda görmeyen hastalarda; ağrıları azalmasını sağlayan minimal invaziv bir teknik olabilir.

Anahtar Kelimeler

lomber disk hernisi, perkütan intradiskal enjeksiyon, radyoopak jel etanol, görsel analog skor

Kaynakça

• Barrero LH, Hsu YH, Terwedow H: Prevalence and physical determinants of low back pain in a rural Chinese population. Spine 31: 2728-2734, 2006
• 2) Bellini M, Romano DG, Leonini S, Grazzini I, Tabano C, Ferrara M, Piu P, Monti L: A Cerase 2 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 36: 600-605, 2015
• 3) Borenstein DG: Chronic low back pain. Rheum Dis Clin North Am 22: 439-456, 1996
• 4) Galluzzi KE: Management of neuropathic pain. J Am Osteopath Assoc 105: 119, 2005
• 5) Gautam S, Rastogi V, Jain A, Singh AP: Comparative evaluation of oxygen-ozone therapy and combined use of oxygen-ozone therapy with percutaneous intradiscal radiofrequency thermocoagulation for the treatment of lumbar disc herniation. Pain Practice 11: 160-166, 2011
• 6) Gazzeri R, Galarza M, Neroni M, Esposito S, Alfieri A: Fulminating septicemia secondary to oxygen-ozone therapy for lumbar disc herniation: case report. Spine 32: 121–123, 2007
• 7) Gibson JN, Waddell G: Surgery for degenerative lumbar spondylosis: updated cochrane review. Spine 30: 2312–2320, 2005
• 8) Ginanneschi F, Cervelli C, Milani P, Rossi A: Ventral and dorsal root injury after oxygen-ozone therapy for lumbar disk herniation. Surg Neurol 66: 619-621, 2006
• 9) Goupille P, Mulleman D, Mammou S, Griffoul I, Valat JP: Percutaneous laser disc decompression for the treatment of lumbar disc herniation: a review. Semin Arthritis Rheum 37: 20–30, 2007
• 10) Han HJ, Kim JY, Jang HY, Lee B, Yoon JH, Jang SK, Choi SH, Jeong SW: Fluoroscopic- guided intradiscal oxygen-ozone injection therapy for thoracolumbar intervertebral disc herniations in dogs. In Vivo 21: 609–613, 2007
• 11) Heron 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 20: 526-532, 2007
• 12) Kawaguchi Y, Matsui H, Gejo R, Tsuji H: Preventive measures of back muscle injury after posterior lumbar spine surgery in rats. Spine 23: 2282–2287, 1998
• 13) Legrand E, Bouvard B, Audran M, Fournier D, Valat JP: Sciatica from disk herniation: medical treatment or surgery? Joint Bone Spine 74: 530–535, 2007
• 14) Lo Giudice G, Valdi F, Gismondi M, Prosdocimo G, de Belvis V: Acute bilateral vitreo-retinal hemorrhages following oxygen-ozone therapy for lumbar disk herniation. Am J Ophthalmol 138:175-177, 2004
• 15) Luijsterburg PA, Verhagen AP, Ostelo RW, van Os TA, Peul WC, Koes BW: Effectiveness of conservative treatments for the lumbosacral radicular syndrome: a systematic review. Eur Spine J 16: 881–899, 2007
• 16) Martin DJ, Rad AE, Kallmes DF: Prevalence of extravertebral cement leakage after vertebroplasty: procedural documentation versus CT detection. Acta Radiol 53: 569–572, 2012
• 17) Muralikuttan KP, Hamilton A, Kernohan WG, Mollan RA, Adair IV: A prospective randomized trial of chemonucleolysis and conventional disc surgery in single level lumbar disc herniation. Spine 17: 381–387, 1992
• 18) Oláh M, Molnár L, Dobai J, Oláh C, Fehér J, Bender T: Evaluation of the efficacy of conservative therapies with clinical parameters and magnetic resonance ımaging in lumbar disc herniations. Rheumatol Int 28: 749-756, 2008
• 29) Oliphant D: Safety of spinal manipulation in the treatment of lumbar disk herniations: A systematic review and risk assessment. J Manipulative Physiol Therap 27: 197-209, 2004
• 20) Riquelme C, Musacchio M, Mont’Alverne F, Tournade A: Chemonucleolysis of lumbar disc herniation with ethanol. J Neuroradiol 28: 219–229, 2001
• 21) Sharps LS, Isaac Z: Percutaneous disc decompression using nucleoplasty. Pain Physician 5: 121-126, 2002
• 22) Sinan T, Sheikh M, Buric J, Dashti K, Al-Mukhaimi A: Percutaneous coblation nucleoplasty in patients with contained lumbar disc prolapse: 1 year follow-up in a prospective case series. Acta Neurochir Suppl 108: 107-112, 2011
• 23) 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 31: 1454-1456, 2010
• 24) 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 20: 526–532, 2007
• 25) Weber BR, Grob D, Dvorak J, Muntener M: Posterior surgical approach to the lumbar spine and its effect on the multifidus muscle. Spine 22: 1765–1772, 1997
• 26) Zhu H, Zhou XZ, Cheng MH, Shen YX, Dong QR: The efficacy of coblation nucleoplasty for protrusion of lumbar intervertebral disc at a two-year follow-up. Int Orthop 35: 1677-1682, 2011