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Aim Paravertebral ozone injection is a new treatment method described in the literature for low back pain. The aim of this study was to compare the pre‐ and post‐treatment pain scores of patients undergoing paravertebral ozone/oxygen (O3/O2) injections for low back pain. Methods From September 2018 to December 2018, 122 patients who underwent paravertebral ozone injections due to low back pain were examined retrospectively; 62 patients who met the study criteria were included. The patients were injected with 15 µg/mL (50 mL) O3/O2 gas in the paravertebral space. The subjects were treated every 7 days for 6 total session. The VAS and Oswestry Disability Index (ODI) scores were assessed before treatment and after treatment (first and third months). The patients’ body mass indexes (BMIs) were measured before the injections. Results There were 12 male patients and 50 female patients. The mean age was 51.9 (range 25 to 71) years. The mean duration of pain was 9.1 (3 to 24) months. Significant improvements were observed in the statistical comparison of VAS and ODI scores between the pre‐injection and first month controls (P < 0.000). There was no significant difference in the statistical comparison of VAS and ODI scores between the first and third months (P < 0.05). There was no statistically significant difference between BMI and pain scores (P > 0.213). Conclusion Paravertebral O3/O2 gas is a reliable and effective treatment for the treatment of lumbar disc herniation, radicular pain, and mechanical back pain due to low back pain.

Study DesignThe study retrospectively investigated 15 cases with multilevel noncontiguous spinal fractures (MNSF).PurposeTo clarify the evaluation of true diagnosis and to plane the surgical treatment.Overview of LiteratureMNSF are defined as fractures of the vertebral column at more than one level. High-energy injuries caused MNSF, with an incidence ranging from 1.6% to 16.7%. MNSF may be misdiagnosed due to lack of detailed neurological and radiological examinations.MethodsPatients with metabolic, rheumatologic diseases and neoplasms were excluded. Despite the presence of a spinal fracture associated clearly with the clinical picture, all patients were scanned within spinal column by direct X-rays, computed tomography and magnetic resonance imaging. When there were ≥5 intact vertebrae between two fractured vertebral segments, each fracture region was managed with a separated stabilization. In cases with ≤4 intact segments between two fractured levels, both fractures were fixed with the same rod and screw system.ResultsThere were 32 vertebra fractures in 15 patients. Eleven (73.3%) patients were male and age ranged from 20 to 64 years (35.9±13.7 years). Eleven cases were the American Spinal Injury Association (ASIA) E, 3 were ASIA A, and one was ASIA D. Ten of the 15 (66.7%) patients returned to previous social status without additional deficit or morbidity. The remaining 5 (33.3%) patients had mild or moderate improvement after surgery.ConclusionsThe spinal column should always be scanned to rule out a secondary or tertiary vertebra fracture in vertebral fractures associated with high-energy trauma. In MNSF, each fracture should be separately evaluated for decision of surgery and planned approach needs particular care. In MNSF with ≤4 intact vertebra in between, stabilization of one segment should prompt the involvement of the secondary fracture into the system.

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difficulties, especially the persistence and recurrence of symptoms. Failure of surgical treatment for LDH can be caused by the true recurrence of disc herniation, new disc herniation at a different disc level, epidural fibrosis, arachnoiditis, foraminal stenosis, and segmental instability (8, 21-23, 29, 30, 32). The overall rate of unsatisfactory discectomy results range from 5% to 20% of recurrent disc herniation and it is the major █ INTRODUCTIONLumbar discectomy is the most common surgical procedure performed by spine surgeons for patients complaining of back and leg pain. Numerous new techniques have been used to improve the efficacy of the surgical excision of herniated intervertebral discs but these procedures still include some AIM: Failure of surgery for lumbar disc herniation (LDH) can be commonly caused by recurrence. There are many debates regarding the risk factors of recurrent LDH (rLDH) and it is very difficult to define them because many clinical and complicated biomechanical parameters are involved. The purpose of study was to evaluate the long term result of re-discectomy for LDH at the same level and adjacent segments. MATERIAL and METHODS:Between 1999 and 2009, 1898 cases were operated and 142 (6.4%) patients underwent re-discectomy following initial operation. The study included 65 patients who were operated for single level discectomy, and their charts were analyzed retrospectively. RESULTS:There were 33 (50.8%) women and mean age was 45.5 years (24-73 years). rLDH was diagnosed at the initial level in 40 (61.5%) but adjacent and/or opposite level herniation (with or without the first level) was found in the remaining 25 cases (39.1%). Recurrence at the same level (SLG) and adjacent level groups (ALG) were similar according to the clinical outcomes in follow-up (mean 34.1 months). Admission period after initial operation was also parallel in SLG and ALG (54.7 and 53.1 months, respectively). However, the mean age of ALG (49.4 years) was significantly higher (p≤0.05) than SLG (42.8 years). CONCLUSION:After discectomy, collapsed discs are biomechanically more stable than those with preserved disc heights, and responses to axial compression on intervertebral disc pressure produced deformations of adjacent levels despite limitations.Altered biomechanical loading next to a fusion resulted in ongoing degeneration with aging at the affected entire lumbar spine.

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