The outcomes with radiopaque gelified ethanol in patients with lumbar disc herniation

Lumbar disc herniation is a condition that has medical and socio-economic consequences. The administration of radiopaque gelified ethanol (RGE) is a minimally invasive method used in the treatment of lumbar disc herniation. The aim of the present study was to evaluate the outcomes in patients who were diagnosed with lumbar disc herniation at our clinic and who rejected surgery and then received RGE injections, for which there is limited data in the literature. The present study retrospectively reviewed 44 intradiscal RGE injections that were performed on 41 patients, who were diagnosed with lumbar discopathy within the one-year period between January 2013 and January 2014 based on the clinical and radiological findings. The patients were evaluated for demographic characteristics, previous therapies, and control magnetic resonance imaging at six months at the earliest, visual analogue scale (VAS) pain scores at baseline and six months after RGE injection, complications, side effects, and patient satisfaction after the procedure. Pain was evaluated at baseline and six months after the procedure using VAS. The decreases in VAS pain score were statistically significant. Demographic characteristics also included age and gender of the patients. Accordingly, the records of a total of 41 patients were processed (14 males, 34.1%; 27 females, 65.9%). The mean age was 51.2  17.1 years in males and 47.7  13.8 years in females. The level of lumbar disc herniation was assessed using MR images, and seven cases had a disc herniation at the level of L3-L4 (17.1%), 19 cases had a disc herniation at the level of L4-L5 (46.3%), and ten cases had a disc herniation at the level of L5-S1 (24.1%). When the patients were evaluated according to MR imaging findings and previous therapies for lumbar disc herniation, 19 patients had diffuse bulging, 22 patients had disc protrusion, and six of 41 patients did not receive a previous therapy. Of these patients, 20 received transforaminal steroid injection (TFS) and 15 received only drug therapy (non-steroidal anti-inflammatory drugs, myorelaxants, steroids, etc...). When patient satisfaction was assessed orally after RGE injection, four patients reported dissatisfaction, while 13 patients were moderately satisfied, 13 patients were satisfied, and 11 patients were very satisfied. In other words, patients that reported dissatisfaction accounted for 9.8% of the study population. Control MR images were obtained for 11 patients. Recovery on MR images was observed in seven patients that had disc protrusion, and one patient that was known to have diffuse bulging showed no change on control MR imaging. No significant difference was found when the satisfaction was evaluated according to MR imaging findings and age. In conclusion, we suggest that radiopaque gelified ethanol (REG) injection is a safe, minimally invasive method that can be used as an alternative to surgery in the treatment of pain associated with lumbar radiculopathy secondary to disc pathologies in patients that cannot be treated with a conservative method; it offers functional improvement, decreases in analgesic consumption, and increases in the quality of life of these patients. Keywords: Lumbar disc herniation, trans-foraminal steroid, radio-opaque gelified ethanol, visual analogue scale