Fibrin as a Sealant for Treatment of Disc Tears

Paper: Treatment of annular disc tears and “leaky disc syndrome” with fibrin sealant

Authors: Kevin Pauza, MD, Carrie Wright, BS, Adam Fairbourn, BS

Link to article

Internal disc disruption or “Leaky Disc Syndrome” is caused by annulus fibrosus (AF) tears which allow the nucleus pulposus to leak out of the intervertebral disc and irritate and inflame surrounding nerves, causing pain. Current surgical and non-surgical treatments for Leaky Disc Syndrome do not address the underlying cause of pain (leakage due to AF tears) or the abnormalities in surrounding discs. Many surgical options cause accelerated degeneration in adjacent discs. The study proposes that applying a fibrin sealant over AF tears will stop the nucleus pulposus leakage, alleviating nerve inflammation and pain. The fibrin sealant forms a bio adhesive glue that immediately mechanically seals the annular tears and prevents further leakage. A potential secondary benefit of the sealing effect of fibrin is that it keeps regenerative biologics in the disc which optimizes their efficiency. 

The patient lies prone on the table and is administered prophylactic antibiotics and is put into mild conscious sedation using short acting sedatives of analgesics. The lumbar intervertebral discs are visualised using fluoroscopy where a needle will be directed towards the posterior AF. When the correct position is found, the needle is inserted into the center of the posterior AF. A contrasting dye is injected through the needle which allows visualization of the AF’s flow pattern under fluoroscopy. If a tear is identified, the needle remains in place as subsequent discs are tested in the same manner. Once diagnostics are completed, the same needles are used to inject a fibrin sealant over the tears of the affected discs, returning them to normal morphological appearance radiographically. The pressure of each affected disc was tested pre-treatment and 5 minutes post-treatment using the contrasting dye and digital manometry. The pressure from unaffected discs was taken during diagnostics only. Patients were discharged 60 minutes after dressing the sites.

The study included 108 patients with lower back pain. The average number of abnormal lumbar intervertebral discs per patient was 3. The study evaluated 540 lumbar discs in total in 108 sequential patterns over a 23-month period. Of the 540 lumbar discs, 347 (64%) showed abnormal annulus fibrosus morphology. For these 347 discs, there was a significant improvement of pressure between pre- and post-treatment of 103.45kP (p<0.001).

The study concluded that fibrin sealant on AF tears improves intradiscal disc pressure and may assist in repairing AF tears and containing intradiscal biologics which cause lower back pain. It was recommended to physicians to treat at least 3 discs during the procedure for optimal results, given that the average patient showed abnormal morphology on 3 discs.