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Ethanol Gel & Disk Disease

Clinician's Brief (Capsule)

Neurology

|July 2016

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Two types of intervertebral disk disease (IVDD) are described in veterinary medicine: nuclear extrusion and annular protrusion. Dogs with acute nuclear extrusion and intact pain perception typically have a good prognosis following surgical removal of extruded disk material. Dogs with surgically treated annular protrusion tend to have worse prognoses. 

Minimally invasive therapy has been described as an alternative to surgery for chronic disk protrusions. The goal of these procedures is to decrease intradisk pressure or to dehydrate the nucleus pulposus and cause the herniated portion of disks to recede. Injection of radiopaque ethanol gel preparation into the nucleus pulposus has been described as a useful agent for treating human intervertebral disk protrusion. 

This experimental, descriptive, prospective study aimed to assess the feasibility and safety of percutaneous ethanol gel injection into the lumbosacral intervertebral disks of dogs. The lumbosacral intervertebral disks of 9 normal dogs were imaged with MRI then injected with ethanol gel under CT guidance. The procedure successfully delivered radiopaque ethanol gel to the nucleus pulposus in each dog. Leakage into the vertebral canal was present in 3 dogs immediately following injection and in an additional dog 1 year after the procedure. No adverse events were documented. The authors concluded that ethanol gel injection into the lumbosacral intervertebral disks of healthy dogs is feasible and well-tolerated.

Ethanol gel injection into the lumbosacral intervertebral disks of healthy dogs is feasible and well-tolerated.

Commentary

IVDD with annular protrusion (ie, Hansen Type II IVDD) in dogs is similar to the condition in humans; thus, it is reasonable to look to human medicine for alternative treatment options. Though relatively new, chemonucleolysis has shown promising results in humans.1 The results of this study indicate that injection of the nucleus is feasible in dogs. Given the morbidity and unpredictable clinical outcome following surgical treatment of Type II IVDD in dogs, such a minimally invasive approach is appealing. Clinical studies are necessary to determine whether the procedure is feasible and safe in dog breeds prone to Type II IVDD and dogs with degenerative disks as well as to determine efficacy compared with surgical treatment.—Sara Colopy, DVM, DACVS, University of Wisconsin

This capsule is part of the One Health Initiative.

References

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