Percutaneous injection of radiopaque gelified ethanol for the treatment of lumbar and cervical intervertebral disk herniations: experience and clinical outcome in 80 patients.
OBJECTIVE
Chemonucleolysis represents a minimally invasive percutaneous technique characterized by an intradiskal injection of materials under fluoroscopic or CT guidance. Recently, a substance based on radiopaque gelified ethanol has been introduced. The purpose of this study was to describe the indications, procedure, safety, and efficacy of radiopaque gelified ethanol in the percutaneous treatment of cervical and lumbar disk herniations.


METHODS
Between September 2010 and August 2013, 80 patients (32 women and 48 men; age range, 18-75 years) were treated for 107 lumbar disk herniations (L2-L3, n = 1; L3-L4, n = 15; L4-L5, n = 53; and L5-S1, n = 38) and 9 cervical disk herniations (C4-C5, n = 2; C5-C6, n = 2; C6-C7, n = 3; and C7-D1, n = 2) by percutaneous intradiskal injection of radiopaque gelified ethanol under fluoroscopic guidance. Thirty-six patients underwent a simultaneous treatment of 2 disk herniations. Patient symptoms were resistant to conservative therapy, with little or no pain relief after 4-6 weeks of physical therapy and drugs. All patients were evaluated by the Visual Analog Scale and the Oswestry Disability Index.


RESULTS
Sixty-two of 73 (85%) patients with lumbar disk herniations and 6/7 (83%) patients with cervical disk herniations obtained significant symptom improvement, with a Visual Analog Scale reduction of at least 4 points and an Oswestry Disability Index reduction of at least 40%. Leakage of radiopaque gelified ethanol in the surrounding tissues occurred in 19 patients, however without any clinical side effects.


CONCLUSIONS
In our experience, percutaneous intradiskal injection of radiopaque gelified ethanol is safe and effective in reducing the period of recovery from disabling symptoms.
From the Neuroimaging and Neurointerventional Unit - NINT (M.B., D.G.R., S.L., M.F., L.M., A.C.) matteo.bellini@icloud.com.
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http://orcid.org/0000-0001-5280-0526
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Bellini
From the Neuroimaging and Neurointerventional Unit - NINT (M.B., D.G.R., S.L., M.F., L.M., A.C.).
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Romano
From the Neuroimaging and Neurointerventional Unit - NINT (M.B., D.G.R., S.L., M.F., L.M., A.C.).
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Leonini
Department of Medical, Surgical and Neuro Sciences, Diagnostic Imaging (I.G.), University of Siena, Siena, Italy.
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Grazzini
Unit of Radiology (C.T.), Hospital of Arzignano, Vicenza, Italy.
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Tabano
From the Neuroimaging and Neurointerventional Unit - NINT (M.B., D.G.R., S.L., M.F., L.M., A.C.).
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Ferrara
Unit of Neurology (P.P.), Department of Neurological and Neurosensorial Sciences, Hospital "Santa Maria alle Scotte," Siena, Italy.
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Piu
From the Neuroimaging and Neurointerventional Unit - NINT (M.B., D.G.R., S.L., M.F., L.M., A.C.).
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Monti
From the Neuroimaging and Neurointerventional Unit - NINT (M.B., D.G.R., S.L., M.F., L.M., A.C.).
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Cerase
D000279:Administration, Cutaneous; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002492:Central Nervous System Depressants / Q000008:administration & dosage* / Q000627:therapeutic use*; D000431:Ethanol / Q000008:administration & dosage* / Q000627:therapeutic use*; D005260:Female; D005782:Gels / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007267:Injections / Q000379:methods; D007403:Intervertebral Disc / Q000000981:diagnostic imaging; D007404:Intervertebral Disc Chemolysis / Q000379:methods*; D007405:Intervertebral Disc Displacement / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011859:Radiography; D016896:Treatment Outcome; D055815:Young Adult
D002492:Central Nervous System Depressants; D005782:Gels; D000431:Ethanol