ESRA Academy. Koetsier E. Sep 8, 2016; 138281; 0105 Topic: PAIN THERAPY (ACUTE - CHRONIC)
Mrs. Eva Koetsier
Mrs. Eva Koetsier

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Background and Aims:

Degenerative disc disease is one of the most common spinal pathologies. It is associated with disc dehydration, volume reduction, changes in cellular activity, biomechanical changes and painful symptoms. Analgesics and physical therapy often provide only temporary relief. There is controversy about the effectiveness of treatments like intradiscal injections (methylene blue), electrothermal therapy and biacuplasty. Furthermore, fusion or total disc arthroplasty are highly invasive surgeries with significant associated morbidity.

The hydrogel (GelStix™ Nucleus Augmentation Device) is composed of a hydrogel polymer, which expands in volume when implanted intradiscally. It acts as a reservoir of hydration, producing increased pressure, improved fluid exchange, and pH balance (figure 1).

We present a successful case of hydrogel implantation for the treatment of discogenic pain.


A 44-year-old man presented with discogenic pain since one year, confirmed by MRI (figure 2). Before treatment he graded his pain as 8/10, despite being treated with physiotherapy and analgesics including 120 mg morphine daily. The hydrogels were inserted through the an 18 gauge needle in the nucleus pulposus (figure 3).


At 1 month follow-up, the patient reported reduction of pain to 2/10 and a reduction of morphine intake to 80 mg daily. He was able to walk better and was very satisfied with the treatment. At 3 months follow-up, the patient reported a pain score of 3/10, and the morphine consumption could be reduced to 35 mg daily.


Hydrogel implantation can be a meaningful solution for the treatment gap existing between conservative care and invasive surgical intervention.

Reference: Kallewaard. Pain Pract. 2010;10:560-79.

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