Joint Surgeons in Germany

Gelenk Klinik Orthopaedic Clinic

Street:
Alte Bundesstrasse 58

Town:
D-79194 Gundelfingen

Germany

fon: +49-761-55 77 58 28

fax: +49-761-58 974 650

clinic@joint-surgeon.com

Hydrogel - Filling the degenerated spinal disc with chondroid gel

Key Facts of Hydrogel Injection Therapy

  • Indication: Painful spinal disc degeneration
  • Strategy: A small tube is inserted into the affected disc. Waterbinding substances are inserted that will increase the spinal disc volume in order to decrease pain and improve function.
  • Inpatient treatment: 3 days
  • Rehabilitation treatment: 14 days outpatient or inpatient rehabilitation
  • Earliest flight home: 7 days after surgery
  • Recommended flight home: 21 days after surgery
  • Time before showering: 1 day after surgery
  • Recommended time off work: 28 days
  • Time before driving a car: 14 days
Fig. 1: The generated disc has a reduced volume. The height of the disc space is reduced. This causes increasing strain on the vertebral body and the facet joints (vertebral joints), resulting in pain. Injecting the hydrophylic Hydrogel draws fluid back into the disc. The volume, thus the height of the disc space, increases. Disc function increases again. © www.arthrovision.de

Back pain can have a number of different causes.

One common cause is degeneration of the disc. Wear or loss of disc tissue is a normal part of ageing. The loss of fluid, loss of protein structure over the course of life cause the disc to change. It becomes less and less elastic, fragile and its height decreases.

Increasing the disc volume with Hydrogel

Using the Hydrogel injection method we’d like to illustrate how we can counteract the loss in height in the degenerated disc: By injecting the highly expansive polymer substance Hydrogel considerably increases water retention in the viscid core of the disc. The highly water-binding, expansive Hydrogel increases the disc diameter in the long term again. This effect lasts for years.

Back pain due to disc degeneration

Unfortunately the results of these change in the disc can often be felt. Disc wear in adjoining vertebrae increase the pressure load. This in turn triggers an inflammatory reaction in the vertebrae, described by the technical term osteochondrosis. There are various stages and is distinguished by classification by Modic. Disc pain is then worse or less depending on the stage.

Back pain due to disc degeneration

Caution: Herniated disc
With a herniated disc, degeneration of the spine has progressed resulting in a hole in the tough case. Before treating a degenerated disc with Hydrogel this hole first needs to be closed tightly. This can be done using special membranes which are attached to the outside of the disc, so the so-called annulus prosthesis is attached as a closure in correcting a herniated disc. (Barricaid®-procedure)

Pain which occurs with so-called erosive osteochondrosis can be quite severe. They manifest through load-dependent pain, e.g. early in the morning after rising and increasing throughout the day. This pain characteristically does not decrease at night and with bed rest, so that night-time rest is interrupted by back pain. This is often exasperating to patients, as no sleeping position provides relief. In this case the cause is often the inflammation of the discs and the adjoining vertebrae.

LEFT: The Hydrogel sticks a few mm long are inserted into the disc through a hollow needle. RIGHT: Hydrogel as a stick (top) and swollen (bottom) after retaining water. The very high swelling property significantly increases the disc volume. Fig. 2: LEFT: The Hydrogel sticks a few mm long are inserted into the disc through a hollow needle. RIGHT: Hydrogel as a stick (top) and swollen (bottom) after retaining water. The very high swelling property significantly increases the disc volume.

Treatments for disc degeneration

Fusion or disc prosthesis?

In the past, essentially the only available surgical treatment was implanting a disc prosthesis or fusing the disc segment. In both cases, the diseased disc was removed and replaced by implants. Unfortunately, both treatments still posed a fairly high failure rate as symptoms often did not improve or problems of a different nature developed in the same location.

Autologous disc cell transplantation (ADCT)

Until now, the only alternative for this dilemma was autologous disc cell transplantation (ADCT). Whilst this procedure is low risk, it does hold the drawback of being costly and not always being covered by public and private health insurance. In addition, this procedure has the drawback that the vitality of the disc cells inserted could only be indirectly assessed by MRI a few months later. Even with this method of disc regeneration using autologous (the body’s own) disc cells a fairly high failure quote had to be expected.

Hydrogel: Increasing the disc volume with water-binding substances

Fig. 3: Treating disc degeneration with Hydrogel: The water-binding, highly swelling polymer is injected into the inner core of the disc (nucleus pulposus) using a transcutaneous hollow needle. Fig. 3: Treating disc degeneration with Hydrogel: The water-binding, highly swelling polymer is injected into the inner core of the disc (nucleus pulposus) using a transcutaneous hollow needle. © www.arthrovision.de

Hydrogel as an easy to use injection procedure has been successfully used for disc degeneration for a several years.

This type of treatment is based on two active principles:

For one we want to stop the degenerative inflammatory reaction in the disc responsible fro the problems and primarily responsible for the back pain.

n addition, it replaces low cell or no-cell disc material with synthetic disc material - the water-binding Hydrogel. This increases the disc volume and reduces strain on the vertebrae.

Hydrogel surgical procedure

The Hydrogel procedure is a very simple surgical procedure. It only requires a small area of local anaesthesia. It does not require general anaesthesia or stressful medicinal complimentary therapy.

The disc compartment is punctured with a small hollow needle, monitored by x-ray. The very thin synthetic disc stick only a few millimetres long are then inserted through this needle. The correct position inside the disc is also monitored by x-ray. The typical procedure lasts about 10-20 minutes.

Follow-up care for Hydrogel treatment of disc degeneration

The success of the procedure may be reviewed after about a quarter of a year. On principle, however, the subjective alleviation of problems - a decrease in the discogenic back pain - with back pain is the best indication of a successful procedure.

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Orthopaedic Clinic Germany

orthopedic clinic and surgeon in Germany

Gelenk Klinik Orthopaedic
Clinic

ISO 9001:2008 certified quality

Street:
Alte Bundesstrasse 58

Town:
D-79194 Gundelfingen

Germany

Back & Spine Specialists

Team of orthopedic surgeons in Germany

Bijan Ganepour
Expert Consultant for Spine and Neurosurgery

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  • Distance to EURO-Airport Basel: 80 km (45 mins)
  • Distance to Zurich: 161 km (1h 40)
  • Distance to Frankfurt: 259 km (2h 20)

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