A few years ago, a gel was invented that can be placed in the inside of the damaged intervertebral disc, subcutaneously with an injection, local anesthesia, and the assistance of the portable X-ray machine (C-arm). Until recently, it was thought that this material acted osmotically by concentrating water molecules in the nucleus pulposus and restructuring its detached parts. This mechanism would consequently decompress the nerve that had been pressed by a herniation. Unfortunately, the actual results of this material in the treatment of large lumbar or cervical herniations have not been encouraging.
It has been observed, though, that in many cases of smaller herniations, as well as in cases of disc degeneration (black disc), there is an impressive improvement in the symptoms (lumbar or neck pain).
MAST Treatment (Modic Antibiotic Spine Therapy)
Two recent European studies (Research Department of the Spine Center of Southern Denmark, University of Southern Denmark, Odense) solved the mystery of why this gel only acted on degenerated discs and smaller herniations and not on larger herniations. Forty-six percent of patients suffering from an intervertebral disc herniation, in the lumbar spine, host an anaerobic microbe within the suffering disc (Propionibacterium acnes) alone (43%) or with a second anaerobic microbe as well (7%).
This anaerobic microbe defines the appearance of the bone marrow edema to a degree (Modic I changes) to the neighboring vertebral bodies. This can be observed in special sequences in the MRI scan. Long-term (lasting 100 days) oral treatment with special antibiotics (MAST treatment: Modic Antibiotic Spine Therapy) lead to a decrease or even complete elimination of chronic symptoms in some patients with specific characteristics.
Based on the above, it seems that the intradiscal gel is probably effective because of the local antimicrobial action of the included alcohol, despite its osmotic properties. This makes it ideal for the local treatment of chronic pain in the lumbar spine and chronic pain in the cervical spine without nerve root pain in the limbs, because its infusion in the suffering disc “sterilizes” it in a way from all anaerobic microbes.
MAST Treatment and Discoplasty
The combination of these two treatments may increase their effectiveness and lead in the patient’s recovery faster.
The combination of these two treatments (MAST Treatment and Discoplasty) may prevent a heavy operation, such as a spinal fusion on patients with chronic pain in the lumbar spine without sciatica or thigh pain. However, this combination is not indicated, at the moment, for patients with nerve root pain in the foot or in the hand because these cases require surgical decompression, (laminectomy, foraminotomy, etc.) and possibly simultaneous stabilization with spinal fusion.
The application of this treatment should always be performed by a spine surgeon, after a recent MRI scan of the suffering area, because there is a small chance of a gel leak toward the nerve formations and this may cause complications.