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Radiology University of Cagliari, Italy San Giovanni di Dio Hospital Chairman: Prof. Giorgio Mallarini. DISCOGEL the first 6months of experience. Stefano Marcia, MD. Indications. Contained discal herniation (it is essential to have integrity of the anulus fibrosus) Pfirmann grade 1-3
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Radiology University of Cagliari, Italy San Giovanni di Dio Hospital Chairman: Prof. Giorgio Mallarini DISCOGEL the first 6months of experience Stefano Marcia, MD
Indications Contained discal herniation (it is essential to have integrity of the anulus fibrosus) Pfirmann grade 1-3 Failure of medical and physioteraphic treatmentfor at least 6 weeks
- Non contained discal herniation (fissurations of the anulus fibrosus) - Efficacy of medical and physioteraphic treatment - Coagulations disorders - Local and sistemic infections - Canal stenosis - Spondilolistesis - Instability - Fractures - Cauda syndrome - Prior surgical treatments at the same level Controindications
Clinical history Clinical evaluation(O.E.) MRI Patients selection
Clinical evaluation The pain resists to the pharmacological therapy and to the extended physiotherapic treatment
MRI T2W image: contained disc herniation in L4/L5
MRI T2W image: intraforaminal disc herniation in L4/L5
Materials and methods Angiographic suite CT suite
January-June 2010 Patients: 33(18M, 15F) Mean age: 49.4 Levels: 37
Follow up Clinical evaluation • VAS 0-10 analysis baseline and at 1m, 6m after the procedure (VAS analysis: positive for reduction ≥2) • ODI 0-100% questionnaire baseline and at 6m after the procedure Imaging • CT check baseline and 1m after procedure with evaluation of the reduction of the volume of the nucleus polposus
Results PAIN REDUCTION: VAS score
Results Oswestry Disability Index(ODI)
Results PAIN REDUCTION: use of analgesic drugs
Results VOLUME REDUCTION Cooperation with Dr.M.Bellini and Dr.D.Romano, Neuroradiology Dpt, Siena, Italy
Conclusions Our data indicates that injection of Discogel is an optimal therapy for symptomatic patients with contained disc herniation A precise patient selection is extremely important in avoiding outcome failure
Thank you stefanomarcia@aoucagliari.it