Centers of Excellence in Interventional Cardiology and Radiology

INTERVENTIONAL NEURORADIOLOGY

Percutaneous Treatment of Cervical Disk Hernias Using Gelified Ethanol

Dr. Rares Nechifor is the most prominent radiologist in Romania.

Our center has saved the lives of over 4,500 patients in the last 4 years

The most modern equipped angiography room , an exceptional medical team

The simplest method of treating a herniated disc!

Only 24 hours hospitalization!

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031 9300

Generalities

Disc herniation is a disease wich can affect patients of any age. It may result secondary of trauma, from injuries to the spine, different accidents or, in some cases, there isn’t an identified cause ( in this case the disease is know as idiopathic disc herniation).

A herniated disc consists of tiny tears or cracks in the outer layer (annulus or capsule) of the disc. The jellylike material inside the disc (nucleus) may be forced out through the tears or cracks in the capsule, which causes the disc to bulge, break open (rupture), or break into fragments. This is causing severe and constant pain. The disc hernia can lead to a root compression provoking a quality of life degradation.

Arm pain from a cervical herniated disc is one of the more common cervical spine conditions. It usually develops in the 30 – 50 year old age group. Although a cervical herniated disc may originate from some sort of trauma or injury to the cervical spine, the symptoms commonly start spontaneously. The arm pain from a cervical herniated disc results because the herniated disc material “pinches” or presses on a cervical nerve, causing pain to radiate along the nerve pathway down the arm. Along with the arm pain, numbness and tingling can be present down the arm and into the fingertips. Muscle weakness may also be present due to a cervical herniated disc.

Symptoms

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A cervical herniated disc will typically cause pain patterns and neurological deficits as follows:

C4 – C5 – Can cause weakness in the deltoid muscle in the upper arm. Does not usually cause numbness or tingling. Can cause shoulder pain.

C5 – C6 – Can cause weakness in the biceps (muscles in the front of the upper arms) and wrist extensor muscles. Numbness and tingling along with pain can radiate to the thumb side of the hand. This is one of the most common levels for a cervical disc herniation to occur.

C6 – C7 – Can cause weakness in the triceps (muscles in the back of the upper arm and extending to the forearm) and the finger extensor muscles. Numbness and tingling along with pain can radiate down the triceps and into the middle finger. This is also one of the most common levels for a cervical disc herniation.

C7 – T1 – Can cause weakness with handgrip. Numbness and tingling and pain can radiate down the arm to the little finger side of hand.

It is important to note that the above list comprises typical pain patterns associated with a cervical disc herniation, but they are not absolut

Diagnostics

After the initial exam, special diagnostic imaging tests may be required to better diagnose a cervical herniated disc.

The single best test to diagnose a herniated disc is a MRI (Magnetic Resonance Imaging) scan. A MRI scan can image any nerve root pinching caused by a herniated cervical disc.

Occasionally a CT scan with a myelogram may also be ordered, as it is more sensitive and can diagnose even subtle cases of nerve root pinching. Although a CT scan with myelogram is more sensitive it is also a slightly invasive test, as the myelogram dye must be injected into the spinal canal as part of the procedure. Because of the injection, a CT scan with myelogram is not usually the first test ordered.

Plain CT scans (without myelogram) are for the most part not useful for the diagnosis of a herniated cervical disc.

Occasionally, an EMG (electromyography) may also be requested. An EMG is an electrical test that is done by stimulating specific nerves and inserting needles into various muscles in the arms or legs that may be affected from a pinched nerve. If the muscles have lost their normal innervation, there will be spontaneous electrical activity.

An EMG can also help rule out other nerve entrapment syndromes that can give one arm pain.

Indications

1. Conservative treatment: taking anti-inflammatory medications to remove some of the inflammation can reduce this component of the pain, while the pressure component (pinching of the nerve root) resolves. For patients with severe pain from a herniated disc, oral steroids (such as Predisone or a Medrol Dose Pak) may give even better pain relief. However, these medications can only be used for a short period of time (one week).

2. Spine surgery: anterior or posterior discectomy with or without spine fusion. If the arm pain does not get better with conservative treatments, or if the patient has severe pain and disability, then surgery can usually provide quick and reliable relief of the pain. With an experienced spine surgeon, the surgery for a herniated disc is very reliable and can usually be done with a minimum amount of pain and little risk of major complications.

3. Percutaneous treatment using gelified ethanol: this procedure must be performed by a health practitioner used to percutaneous disc punctures.

Procedure

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The procedure is performed in a room that has a special x-ray machine called an ‘angiography suite’ or fluoroscopy room. It is done under local anesthesia. You may receive a sedative to relieve anxiety. Thus, after local asepsy, intervention consists of an injection of gellified ethanol (alcohol) in the salient part of the intervertebral disc which forms hernia. Is made by a antero lateral way in case of cervical hernias.

The gel keeps the alcohol which does not migrate of the disc and the same alcohol causes drainage of hernia.

This drainage is performed by water migration from the bag of hernia towards the internal and central part of the disc, and so releases the pressure on the spinal cord or the nervous root.

Having raised medullar / radicular compression main pain disappears very fast. During the weeks following the treatment, feelings of discomfort may persist. These disappear generally in 6 consecutive weeks after DISCOGEL® injection.

So that the afflicted zone is more completely treated, anti-inflammatory drugs/corticoids can be injected at the level of intervertebral junctions in regard to the treated disc. Recovery is quicker for most of patient.

The quantity of DISCOGEL® injected by disc varies between 0,2 and 0,8 ml, according to the dimension of disc and extent of the hernia.

A syringe of 1mL is provided so that any of these injection volumes is possible.

A needle is inside the kit to withdraw DISCOGEL®from its vial. It is necessary to undertake the filling of the syringe as shown on the photo here above.

Injected gel must be homogeneous at the time of its injection. Kit allows possibly intervening on two discs (a syringe by disc).

Active agent – advantages:

Gelified ethanol (radio opaque marker: medical-legal advantage (site seeable after many months))

Quite spontaneous decompression (conservation of the annulus):

– intradiscal migration of liquid toward the middle of the disc (nucleus pulposus)

– simultaneous deposition of a prosthesis at the injection site.

Absence known allergy

No inflammation

Absence of pain consecutive to treatment

Absence of interdiscal compression due to a disc collapses

During a single procedure many discs can be treated with one vial

High of the disc preserved during life time

Quick results:

– 3 to 5 weeks

– back to work after 5 weeks (instead of 3 months with classical satisfactory surgery)

No recidivism observed (experience>5years)

No scary

Surrounding tissues preservation

Is it painful?

No, usually, the intervention is performed under local anesthesia. You will be awake during the procedure and able to tell the radiologist if you become uncomfortable. Your doctor may use a mild sedation, so you remain calm and not anxious.

How long does it take?

The duration of the procedure is about 1 hour.

Risks

The complications are reduced by the proper preparation and the continuous surveillance of the patient. Potential complications:

allergic reactions to administered substances, including renal disfunction

reactions to anesthetic compounds

the failure rate with DISCOGEL ® which required a subsequent conventional surgery later is only 0.7%

Before procedure

The preoperative assessment will establish if the interventional treatment is the best option for you.

Prior to the intervention, the your doctor must be prevented about any history of allergic reactions. Blood tests are taken including hemoglobin level, coagulation, renal function, and other specific tests.

The patient is admitted in the intervention day, and he should not eat before the procedure.

Your doctor will tell you if you should not use some drugs before the prcedure.

After procedure

Most often, this is an outpatient procedure: we come to the hospital have undergone a slight response on the same day we can return home

There is symptomatic improvement between 1 per 6 weeks after injection of DISCOGEL ®. While in comparison to conventional surgery performed well 3 months is required.

Rehabilitation for physical activity (depending on the type of exercise and individuals, but it is about 6 weeks of 3a (compared to three months for a satisfactory conventional surgery without sequelae)

After the intervention of a cervical disc, isn’t necessary to wear a neck brace.

Important!

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STRENGH OF DISCOGEL

Treatment that can be ambulatory

Minimally invasive treatment (limits risks of infection); this intervention respects the integrity of the spine. We do not sectioned postural muscles around the vertebrae and it minimizes the risk of formation of collagen source adhesion and imprisonment of nerve endings that can be irradiated locally during movement.

Local anesthetic

This process does not affect the height of the intervertebral space and the impact on the anatomy of the spine is minimal.

DOCTORS
that perform the procedure

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Sună Mesaj