DiscoGel™ (CE-marked implantable device, opaque gelified ethanol, radiopaque gelified ethanol)
DiscoGel is a relatively new form of chemonucleolysis used for the treatment of symptomatic contained disc herniations and their sequelae (i.e., low back pain and/or lower limb pain).
More specifically, the injectionist administers, through a far lateral approach, a ~1 mL mixture of gelified ethanol, tungsten (to make the goop radiopaque (visible) {you can’t see it on x-ray, fluoroscopy, CT) and ethylcellulose (makes the mixture more viscous – like a cotton ball – so it is less likely to leak out of an annular tear into the epidural space and negatively affect the adjacent neuron structures) into the center of the disc, under fluoroscopic guidance.
As with any pure alcohol-based product, DiscoGel will destroy the cells and substance of the nucleus pulposus which in turn will ostensibly “shrink the radius of the disc”. The shrinking may reduce the size of the disc bulge and/or contained disc herniation and therefore remove irritating pressure on an affected nerve root, decreasing back pain and sciatica.
Warning: this procedure is still completely experimental!
I spent a great deal of time going through several medical literature databases (2016) and failed see a single randomized-controlled trial or meta-analysis testing this procedures efficacy. Furthermore, it is currently not licensed in the United States for use.
Note: the only reason I even mention it is that I've had several clients from Europe who have tried it and are now in worse pain. I'm sure it will be coming soon to the United States so beware.
Warning: there is also a risk of adjacent neural structure damage if the DiscoGel material leaks out of a torn disc (full-thickness annular tear)! Such leakage may potentially cause arachnoiditis, increased radicular pain (sciatica [Theron-2007], permanent nerve root damage or who knows what else!
FINAL COMMENTS
as I’ve said in numerous areas of my website, we know from sheep and human studies that poking the disc with the needle, which is necessitated with all these disc volume reduction techniques, including the DiscoGel procedure, may well have deleterious effects in the long run. Specifically, the needle-stick often greatly speeds up the degenerative process within that disc which leads to chronic discogenic pain, facet joint pain, new annular tear, and even disc herniations.
Therefore, I personally never recommend any of these minimally invasive “disc shrinking procedures” unless they have been well studied through randomized controlled trials. If their efficacy has been established, then they should only be used in a last-ditch effort to avoid interbody fusion.
MEDICAL RESEARCH FOR DISCOGEL
In 2015, Leglise et al publish the results of their retrospective (low-quality evidence) review of 25 patients treated with DiscoGel, all of whom were treated in France. Although this was not a very well done study and obviously way underpowered (not enough patients to really make a statistical statement about), they found that 64% of the patients failed to respond to the treatment!
In 2013, de Seze et al publish the results of their prospective French study on 79 patients undergoing the DiscoGel procedure. There were no serious complications and 63% of the patients reported excellent outcomes.
In 2015, Mackenzie et al reported the one-year results of nine dogs whose discs were injected with DiscoGel. Worrisome was the fact that epidural leakage of the DiscoGel (i.e., the DiscoGel leaked out of the disc and into the epidural space which is where the delicate nerves and thecal sac are) occurred in 33% of the animals during the initial injection and in another 11% of the animals within the one year follow-up. Therefore, all in all, 36% of the animals suffered a leaking of the toxic DiscoGel from the disc into the epidural space! There were, however, no noted clinically adverse reactions– i.e., none of the dogs died.
In 2015, Belini et al reported the results of 80 patients treated with radiopaque gelified ethanol (i.e., a substance very very similar to DiscoGel). Leakage of the ethanol occurred in 24% of these human patients. The follow-up period was unknown; however, 85% of the patients with lumbar disc herniation had at least a 40% reduction of the VAS and ODI.
BOTTOM LINE
Your absolutely crazy to try DiscoGel for the treatment of chronic back pain and/or sciatica. The ethanol base is too powerful and although it definitely will decrease the diameter of the desk, the chances of it leaking out into the epidural space are just too great!