title: Cohort study of lumbar percutaneous chemonucleolysis using ethanol gel in sciatica refractory to conservative treatment.
abstract: OBJECTIVE
  To investigate the efficacy of percutaneous chemonucleolysis using ethanol gel (PCEG) in alleviating radicular pain due to disc herniation after failure of conservative treatment.
  
  
  METHODS
  After failure of conservative treatment, PCEG was performed under fluoroscopic guidance in 42 patients with sciatica >4/10 on a Visual Analog Scale (VAS) for at least 6 weeks and consistent disc herniation on MRI or CT <3 months. The VAS pain score was determined at baseline, then after 1 and 3 months. We assessed the influence of patient-related factors (age, gender, pain duration) and disc herniation-related factors (level, migration pattern, disc herniation-related spinal stenosis) on outcome of PCEG.
  
  
  RESULTS
  Mean pain duration was 6.7 months. Pain intensity decreased by 44% and 62.6% after 1 and 3 months, respectively, versus baseline (P = 0.007). A mild improvement was noted by the rheumatologist in 30/42 (71.4%) and 36/42 (85.7%) patients after 1 and 3 months, respectively, and in 31/42 (73.8%) and 33/42 (78.6%) patients by self-evaluation. Patients who failed PCEG were significantly older (49.8 vs. 37.3 years, P = 0.03). None of the other variables studied were significantly associated with pain relief.
  
  
  CONCLUSIONS
  PCEG may significantly improve disc-related radicular pain refractory to conservative treatment.
  
  
  CONCLUSIONS
  • Percutaneous chemonucleolysis using ethanol gel (PCEG) is feasible on an outpatient basis. • PCEG improves disc-related radicular pain refractory to conservative treatment. • PCEG is feasible on an outpatient basis. • Failure of PCEG does not interfere with subsequent spinal surgery.
authors.affiliation: Radiologie Ostéo-Articulaire, Hôpital Lariboisière, AP-HP, 2 rue Ambroise Paré, 75475, Paris Cedex 10, France. sebastien.touraine@lrb.aphp.fr.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Touraine
authors.affiliation: Rhumatologie, Centre Viggo-Petersen, Hôpital Lariboisière, AP-HP, 2 rue Ambroise Paré, 75475, Paris Cedex 10, France. joel.damiano@wanadoo.fr.
authors.forename: Joël
authors.initials: J
authors.lastname: Damiano
authors.affiliation: Radiologie Ostéo-Articulaire, Hôpital Lariboisière, AP-HP, 2 rue Ambroise Paré, 75475, Paris Cedex 10, France. oliviatran7@gmail.com.
authors.forename: Olivia
authors.initials: O
authors.lastname: Tran
authors.affiliation: Radiologie Ostéo-Articulaire, Hôpital Lariboisière, AP-HP, 2 rue Ambroise Paré, 75475, Paris Cedex 10, France. jean-denis.laredo@lrb.aphp.fr.
authors.forename: Jean-Denis
authors.initials: JD
authors.lastname: Laredo
mesh_terms: D000328:Adult; D002908:Chronic Disease; D000431:Ethanol / Q000627:therapeutic use*; D005260:Female; D005782:Gels; D006801:Humans; D007404:Intervertebral Disc Chemolysis / Q000379:methods*; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000628:therapy; D017116:Low Back Pain / Q000209:etiology / Q000628:therapy; D008159:Lumbar Vertebrae; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D012585:Sciatica / Q000628:therapy*; D013130:Spinal Stenosis / Q000150:complications; D016896:Treatment Outcome
chemical_list: D005782:Gels; D000431:Ethanol
keywords: Disc herniation; Ethanol gel; Percutaneous chemonucleolysis; Radicular pain; Sciatica