OBJECTIVES OF This lecture Define Minimally invasive treatment

OBJECTIVES OF This lecture: * Define Minimally invasive treatment * Explain the purpose of invasive treatment * Describe the procedure of treatment * Different types of Minimally invasive disc treatment * Which one is better?

Different Minimally Invasive Disc Treatments Chronic low back pain is one of the major chronic debilitating conditions involving tremendous loss of money, work, and quality time… discogel-uae. com

Disc herniation classification: A: Normal disc anatomy demonstrating nucleus pulposus (NP) and annular margin (AM). B: Disc protrusion, with NP penetrating asymmetrically through annular fibers but confined within the AM. C: Disc extrusion with NP extending beyond the AM. D: Disc sequestration, with nuclear Fragment separated from extruded discogel-uae. com

No Response? Surgery Minimally Invasive No Response? Conservative Remember: keeping better posture & Strengthen muscles in all 3 steps

Introduction: Chemonucleolysis is an efficient technique for the treatment of back pain; it consists of a percutaneous intradiscal injection that dissolves the nucleus pulposus and lowers intradiscal pressure. discogel-uae. com

Automated percutaneous discectomy * Onik introduced automated percutaneous discectomy in 1985. * This procedure has proved safe and efficacious for treating lumbar disc disease without complications. * The majority of failures occur in patients with free fragments or spinal stenosis * disc infection, developed in fewer than 0. 2% of cases discogel-uae. com

Laser discectomy is an outpatient procedure with one-step insertion of a needle into the disc space. Disc material is not removed; instead, nucleus pulposus is burned by the laser PLDD performed with computed tomographic (CT) and fluoroscopic guidance appears to be a safe and cost-effective treatment for herniated intervertebral discs discogel-uae. com

The aim of PLDD is to vaporize a small portion of the nucleus pulposus of an intervertebral disc, thereby reducing the volume of a diseased disc and the pressure within it In cases of ruptured posterior Longitudinal ligament (ie, epidural leak of contrast medium in discography), PLDD is not indicated. Indications for the operation first of all depend on the clinical symptoms, but the success of the operation depends on the discographic findings. discogel-uae. com

This minimally invasive technique can be performed in patients who need surgical intervention for disc herniation with leg pain from radiculopathy. Exclusion criteria include stenosis or facet hypertrophy and disc fragment discogel-uae. com

Relative contraindications are: progressive neurologic deficit, involvement in workers' compensation cases, and previous surgery at the same disc level. In general, the herniation must have continuity with the parent discogel-uae. com

OZONE! Ozone Discectomy is the injection of Ozone inside the intervertebral disc in trouble There are four main biochemical actions on the intervertebral disc and its surrounding tissues. The various proposed mechanisms of action are: BY “MUMMIFICATION” OF THE DISC BY INHIBITING INFLAMMATORY NOCICEPTORS. BY STIMULATING FIBROBLASTS & IMMUNOSUPPRESSOR CYTOKINES BY IMPROVING MICROCIRCULATION & OXYGENATION. discogel-uae. com

Radiopaque Gelified Ethanol (Discogel) History… Several years ago, the most widely used substance for this was chymopapain, which had an efficacy of close to 80% in lumbar disk herniations and close to 85% in cervical disk hernias but was withdrawn from the market due, in part, to anaphylactic reactions to this enzyme. discogel-uae. com

New Material… After this, the search for a new drug that could have the same efficacy as chymopapain but without the complications led to the use of pure ethanol for chemonucleolysis with very good results and no allergic complications. discogel-uae. com

Problems with Pure Ethanol Properties of ethanol applied with « success » to percutaneous treatment of disco root conflicts Pure ethanol: risk of important epidural & radicular leakages discogel-uae. com

New Looks for More Security… A mixture of Gellified pure ethanol and a thickening substance with tungsten powder. Secured by: Cellulose “gel making action” limiting the risk of epidural leakage of pure ethanol Presence of tungsten particles → monitoring the progression of the gel through the annular cracks under fluoroscopy and CT discogel-uae. com

Radiopaque Gelified Ethanol DISCOGEL® * Tungsten as non ferrous metal MRI possibility * Treatment can be ambulatory * Minimally invasive treatment (limits risks of infection) * Local Anesthesia * Absence of immediate and late complications * The lack of disk space narrowing discogel-uae. com

Patient Selection (Best Candidates for discogel) Note: The Most Important Criteria for Better Response is Correct Patient Selection ! Single Level Symptomatic HD Leg Pain More than Back pain No Response to medical Treatments for 4_6 weeks discogel-uae. com

The Best Pfirmann grade: 1 -3 The Most Important Criteria for Better Response is Correct Patient Selection ! discogel-uae. com

Cardiovascular and Interventional Society of Europe ( CIRSE )

References: * https: //emedicine. medscape. com/article/1145539 -overview * http: //www. sciencedirect. com/topics/medicine-and- dentistry/laserdisc * https: //www. ncbi. nlm. nih. gov/pubmed/23615885 * https: //www. ncbi. nlm. nih. gov/pubmed/2609191 * https: //www. ncbi. nlm. nih. gov/pubmed/23615890 * http: //spinenpain. com/ozone-discectomy-ozonucleolysis-fordisc-prolapse-cervical-lumbar/ * https: //www. researchgate. net/publication/49636086_Mecha nism_of_Action_of_Oxygen_Ozone_Therapy_in_the_Treatme nt_of_Disc_Herniation_and_Low_Back_Pain * https: //www. ncbi. nlm. nih. gov/pubmed/22440607? dopt=Abst ract * https: //www. ncbi. nlm. nih. gov/pubmed/20053805? dopt=Abst ract * https: //www. ncbi. nlm. nih. gov/pubmed/25395657? dopt=Abst ract discogel-uae. com