bfdfixParticipantMarch 16, 2019 at 11:46 amPost count: 3
I’m also interested in Discogel.
My situation is that my L5/S1 has previously herniated and re-sealed itself, and now has very good hydration on an mri scan (when it had herniated it was very black) – However it has very poor posterior disc height, at around 3 or 4mm.
My L4/L5 had previously bulged, it has very good disc height, but the disc is very black, and it has a clear annular tear. I had prp injected into the annulus or both L4/L5 and L5/S1 a couple of months ago and only the L4/L5 generated pain (I was awake for the injections).
I’m going to wait a couple of months to see if I improve, and if not I’m considering an annuloplasty for the annular tear.
However I’m also considering Discogel at L5/S1 to preserve disc height before there is even less there, BUT also at L4/L5, I recently watched a video by a surgeon who specifically said that Discogel kills the annulus fibres, by this I can only assume it also kills the nerves located in the annulus, and could reduce the pain of an annular tear.
There is also Gelstix to consider as an option.
Any thoughts on this are appreciated!!Donald Corenman, MD, DCModeratorMarch 16, 2019 at 6:32 pmPost count: 8436
Your PRP injection acted like a discogram indicating that only the L4-5 disc is currently capable of generating lower back or leg pain (depending upon the type of pain generated).
Your posterior height loss at L5-S1 after the herniation is due to partial loss of nucleus. Remember that a disc herniation has to exit from the inside of the disc through a thru and thru annular tear. The annulus has no real blood supply so the tear won’t heal and is permanent. Placing the discogel packet in the rear of the disc space typically requires insertion through that tear (or the tear made larger) to accommodate the gel.
Since annular fibers have no blood supply, it is hard to “kill’ them but maybe the discogel has material that is necrotic to annular fibers. I am not aware of any study that indicates that.
Dr. CorenmanbfdfixParticipantMarch 17, 2019 at 1:36 amPost count: 3
Thanks for the reply, yes exactly right, the prp has acted as a discogram in this situation.
I’m happy the prp generated back pain, I also had prp injected directly into the facet joints and nerve ablation at the facet joints, which have given zero relief, so hopefully it is just the annular tear.
I believe discogel is inserted through a needle, not through a herniation, as someone with only disc degeneration could have it.
I’m not sure if the forum allows links, but if so I could post a link to the video, or send the link to you directly.
The surgeon clearly knows what he’s talking about, so I believe what he said is correct.
However I’m not sure if killing the nerve fibres would actually help seal an annular tear, I assume not.
What would you suggest for an annular tear?
Also what is your view on an annuloplasty? I’m just not aware of another viable option.
ThanksDonald Corenman, MD, DCModeratorMarch 17, 2019 at 11:06 amPost count: 8436
I have to apologize as I mixed up Discogel with a hydrogel intradiscal nuclear replacement. Discogel is the attempt at the replacement for chymopapain treatments in the 1970s that dissolved the nucleus. Injecting this substance is designed to dissolve and destroy the nucleus, reducing pressure in the disc.
The reason Chymopapain was discontinued was the potential to leak into the spinal canal and cause nerve injury with some patients developing transverse myelitis, a devastating condition where the nerves in the canal are burned due to the caustic nature of Chymopapain (which was an enzyme developed from the papaya fruit).
Reducing the pressure in the disc space can occasionally be helpful for back pain but I don’t recommend it. The nucleus has already dropped pressure from degeneration (like letting air out of a car tire). This would empty the disc and drop the pressure severely. I have seen many patients from the Chymopapain days who eventually needed a fusion probably due to the elimination of the nucleus.
Annuloplasty is an old technique that was around in the 80s and 90s under the form of IDETT (intradiscal electrothermal therapy). A wire was passed into and around the inside wall of the annulus and then electrified which burned the interior wall. It was not effective.
Annular tears that are symptomatic (and there are many that cause no pain) should be treated with core strengthening and epidural steroid injections as well and NSAIDs (if they work).
Dr. CorenmanbfdfixParticipantMarch 17, 2019 at 11:24 amPost count: 3
Thanks very much for the very informative reply!
The possible complications of discogel don’t sound fun at all, and with an annular tear it doesn’t sound relevant to my situation…
However unfortunately I’ve done steroid injections, core exercises and nsaids with absolutely zero difference, the annular tear has been there for two years and hasn’t got better.
I don’t work and haven’t done in that time, although I’m not in 10/10 pain this is due to the fact I do very little to aggravate the disc damage (not working, being careful when I sit etc).
However it’s not realistic at 34 to carry on like this, and my back injury will have been life changing for 3 years in August.
I have osteoporosis and apparently allergies to titanium, nickel and molybdenum so fusion or artificial disc replacement are hugely difficult for me.
I had a MELISA blood test for the metal allergies, but have never had symptoms, my reason for the test was as I was booked in for artifical disc replacement.
Anyway so if there are no other options I feel annuloplasty is my only possible hope, other than maybe stem cells,which have possibly even less documented prrof of success.
Other than an annuloplasty I see my only other option as double fusion with PEEK cages, hoping the screws don’t come lose being metal, and removing them once bone growth has taken place.
I’ve heard of non metal screws for cancer patients for mri imaging, but I believe they are coated in titanium plasma, or have titanium ends.
Any advice is appreciated, as you will see, I’m not in an easy situation!Donald Corenman, MD, DCModeratorApril 6, 2019 at 12:01 pmPost count: 8436
You could consider microdiscectomy as your back pain might be improved (a 50% chance if no leg pain). I think a 2 level fusion could be helpful but you are young and your genetics are such that you have a not insignificant chance of degenerative changes to the levels above in the future. You could consider intradiscal steroid injections. This kills two birds with one stone as the steroid can reduce intradiscal inflammation and the injection can also be treated like a discogram to indicate if one or both discs are pain generators.
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