Intra-Annular Fibrin Discseel® Procedure to Diagnose and Treat Disc Pathology
Kevin Pauza, MD, Maxim Moradian, MD, and Gregory Lutz, MD
The following is an excerpt of a soon to be published book:
Together, the combination of non-provocative annulograms and intra-annular non-autologous fibrin injections at every torn site in the intervertebral disc’s annulus fibrosus defines the Discseel Procedure. Prior attempts to regenerate intervertebral discs utilizing other biologics, including: stem cells (mesenchymal precursor cells), PRP (Platelet Rich Plasma), growth factors and others are promising, but at the time of the writing of this book have not yet been definitively proven to be efficatious11-10.
Logic dictates that efficacy is diminished when biologics they leak from the intervertebral discs and the efficacy may potentially improve if biologics remain within the disc at the intended site of action. In vivo investigations demonstrate that biologics, whether viscous or non-viscous, and even those encapsulated in hydrogels or other delivery systems112 demonstrate a propensity to leak from degenerated or torn intervertebral discs. In one in vivo investigation, all radiolabeled stem cells (MPCs) injected into intervertebral discs of rabbits leaked from those discs, probably negating any potential treatment efficacy11. More disconcerting was the formation of new, exuberant osteophyte formations adjacent to the treated discs11–12. These osteophytes were evident through both radiographic and gross visual inspection. In our clinical experience, the concern over leakage is more likely in post-surgical discs or more severely degenerated discs with more extensive annular tears.
The Discseel Procedure attempts to overcome this potential for injectate leakage by utilizing an FDA-approved, immediate-sealing, non-autologous fibrin to overcome the propensity for leakage. Fibrin is a strong biologic glue and sealant. Equally important, fibrin is also a strong chemotactic agent that may instigate the growth of new disc tissue74,75.