1. 2025;28;25-30Fluoroscopy-guided Intradiscal Radiopaque Gelified Ethanol Injection Using an Anteroposterior View Compared to an Oblique View: A Randomized Controlled Trial
   Randomized Controlled Trial
   Masoud Hashemi, MD, Sina Hassannasab, MD, Payman Dadkhah, MD, Mohammad E. Majd, MD, and Sogol Asgari, MD.

BACKGROUND: This study introduces a new fluoroscopy-guided intradiscal radiopaque gelified ethanol injection technique using the antero-posterior view and compare it to conventional oblique view. Intradiscal procedures, are minimally invasive techniques that aim to reduce pain associated with lumbar disc herniation by modifying the disc material and decreasing pressure on surrounding nerves.

OBJECTIVES: This study introduces a new fluoroscopy-guided intradiscal radiopaque gelified ethanol injection technique using an anteroposterior view compared to the conventional oblique view.

STUDY DESIGN: This is a double blind, randomized trial.

SETTING: A tertiary care center.

METHODS: Patients with radicular leg pain were randomly assigned to receive a radiopaque gelified ethanol injection via an anteroposterior view or oblique view.. The primary outcomes were procedure time, complication rates, and radiation exposure.

RESULTS: A total of 70 patients were randomized to each group (35 for each group). There were no serious complications in either group. Radiation exposure was significantly lower in the anteroposterior view group (36.92 vs 50.46 µGray/m2 [µGy/m2; P = 0.007). The procedure time was also significantly lower in the anteroposterior  group (171 vs 287 seconds; P = 0.001).

LIMITATIONS: Limitations of our trial include the relatively small sample size, the single-center nature of the study, and the short follow-up period. We were also limited in only including patients with moderate body habitus, and patients with only L3 or L4 disc herniation, which might restrict the generalizability of the findings.

CONCLUSION: An anteroposterior view radiopaque gelified ethanol injection is a promising alternative to the conventional oblique view technique for radicular leg pain management. This novel approach offers a safer and more efficient treatment option, reducing radiation exposure and procedure time without compromising clinical outcomes. Its potential to minimize patient discomfort and enhance overall management of radicular leg pain warrants further investigation and widespread adoption.

KEY WORDS: Fluoroscopy, Absolute gel, anteroposterior, oblique, radicular, sciatica, intradiscal, injection technique

Iranian Registry of Clinical Trials registration number: IRCT20180603039966N3

Ethics committee reference number: IR.SBMU.RETECH.REC.1402.454