1. DISCOGEL the first 6months of experience Stefano Marcia, MD Radiology University of Cagliari, Italy San Giovanni di Dio Hospital Chairman: Prof. Giorgio Mallarini

4. Indications Contained discal herniation (it is essential to have integrity of the anulus fibrosus) Pfirmann grade 1-3 Failure of medical and physioteraphic treatment for at least 6 weeks

5. - 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

6.  Clinical history  Clinical evaluation (O.E.)  MRI Patients selection

7. Clinical evaluation The pain resists to the pharmacological therapy and to the extended physiotherapic treatment

8. MRI T2W image: contained disc herniation in L4/L5

9. MRI T2W image: intraforaminal disc herniation in L4/L5

10. CT suiteAngiographic suite Materials and methods

11. Procedure

16. Procedura

17. January-June 2010 Patients : 33(18M, 15F) Mean age: 49.4 Levels: 37

18. Follow up Imaging CT check baseline and 1m after procedure with evaluation of the reduction of the volume of the nucleus polposus 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

19. Results PAIN REDUCTION: VAS score

20. Results Oswestry Disability Index(ODI)

21. Results PAIN REDUCTION: use of analgesic drugs

22. Results VOLUME REDUCTION Cooperation with Dr.M.Bellini and Dr.D.Romano, Neuroradiology Dpt, Siena, Italy

23. 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 Conclusions

24. stefanomarcia@aoucagliari.it Thank you