Evaluating the Safety and Efficacy of Discogel in the Treatment of Herniated Lumbar Disc: A Systematic Review

Abstract

Context: According to WHO statistics, low back pain (LBP) is one of the main causes of disability and problems related to the quality of life in developing and developed countries. Lumbar disc herniation (LDS) is the most common cause of LBP. The goal of this study was to examine the safely and effectiveness of DiscoGel® in the treatment of lumbar disc herniation or sciatica caused by it.
Methods: To assess the clinical effectiveness and safety of the interventions, first the relevant keywords were specified (i.e. DiscoGel®, DiscoGel® chemonucleolysis, minimally invasive percutaneous technique, RGE, radiopaque gelified ethanol, discal lumbosciatica, chronic discogenic low back pain, lumbar, and cervical intervertebral disk herniations); then, related databases were searched up to 02/02/2017 based on the specified search strategy (Cochrane Library, Ovid MEDLINE, Embase, PubMed, Clinicaltrials.gov) and clinical trials as well as cohorts were examined. In addition to extracting intended outcomes (reduction in pain and side effects), a qualitative analysis of the data was performed to examine the safety and effectiveness indices.
Results: The systematic review reached 9 relevant articles, which were on the 2b level on the Oxford CEBM levels of evidence. The results of the study, which involved 772 patients, indicated the safety of the intervention and its effectiveness in reduction of pain and side effects; the intervention led to good clinical outcomes (in some cases, even at very early stages after treatment) due to its low invasiveness. It can be argued that DiscoGel® is safe and effective as a new minimally invasive procedure to treat sciatica caused by the herniated lumbar disc and can be used as a substitute for invasive surgery in unsuccessful medical treatments.
Conclusions: It seems that the percutaneous treatment of vertebral disc leads to better and longerlasting clinical outcomes (pain relief and mobility) compared to noninvasive methods. In addition, noninvasive techniques are significantly more effective and have fewer side effects compared to various surgical options. As a result, these techniques can be suggested as initial treatments or as alternatives to surgery for the treatment of cervical spine and lumbar hernia. However, due to limited sample size and the type of studies, it is necessary to conduct randomized clinical trials to confirm these results.