Chemonucleolysis of lumbar disc herniation with ethanol.

PURPOSE

To demonstrate the efficiency of the treatment of the lumbar disk herniation (LDH) with absolute alcohol.

MATERIALS/METHODS: From June 1997 to September 2000, 118 patients with 126 LDH, 69 males and 49 females, aged 19 to 77 (mean age: 51.1 years) were treated with absolute alcohol nucleolysis. In 75 cases, the LDH were parasagittal, in 30 foraminal, in 17 medial and in 4 extraforaminal. In most cases, the sensitive symptoms and motor or reflex abnormalities corresponded to the lumbar disc herniation level. Nucleolysis was made in ambulatory condition and each patient underwent general anesthesia. All procedures were performed in surgical conditions and controlled under digital fluoroscopy. The disc puncture was laterally made at the junction of middle and posterior thirds of the disc, under strict lateral fluoroscopic control. A discogram was obtained before ethanol injection. Injection dose of absolute alcohol was 0.4 ml. The realization time was about 15 minutes.

RESULT

Total improvement of symptoms was obtained in 97.55% of cases. Two patients remained with low-back pain and the failure treatment rate was 0.84% (1 case).

CONCLUSION

Nucleolysis with ethanol is a very effective, safe and low cost treatment for any kind of LDH, that allows to treat several levels during the same procedure, and can be repeated several times. Nucleolysis with ethanol can be made in ambulatory condition and be proposed to patients who refuse surgical treatment and have allergic background.