Cohort study of lumbar percutaneous chemonucleolysis using ethanol gel in sciatica refractory to conservative treatment

Abstract

Purpose To investigate the efficacy of percutaneous chemonucleolysis using ethanol gel (PCEG) in alleviating ra- dicular pain due to disc herniation after failure of conservative treatment.

Materials and methods After failure of conservative treat- ment, 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, respec- tively, 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.
Conclusion PCEG may significantly improve disc-related ra- dicular pain refractory to conservative treatment.

Key Points
• 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.

cohort study discogel

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