Ozone disc nucleolysis in cervical intervertebral disc herniation: A nonrandomized prospective analysis in 246 patients

Abstract

Background: Inherent complications associated with surgery and limited success of percutaneous minimally invasive procedures make researches wanting for an ideal treatment for cervical disc herniation. Objective: We prospectively study the role of ozone disc nucleolysis in cervical intervertebral disc herniation. Patients and Methods: From January 2008 to December 2020, we prospectively study 246 consecutive patients of cervical disc herniation treated by a single session of intradiscal injection of ozone–oxygen mixture (ozone disc nucleolysis). There were 55% of females and 45% of males. Age ranged from 28 to 68 years with a mean of 47. The outcome was measured on visual analog scale (VAS) scale and neck disability index (NDI) along with Mcnab method. Results: The mean baseline VAS score was 7.87 which became 3.09 at 1 month, 1.42 at 3 months, 1.40 at 6 months, and 1.35 at 1 year. The mean NDI was 36.27 at baseline which improved to 9.24 at 1 month, 6.25 at 3 months, 6.20 at 6 months, and 6.22 at 1 year. This was found to be significant with P < 0.05. Modified McNab criterion showed excellent recovery in 138 (56.10%), good recovery in 50 (20.32%), and fair recovery in 22 (8.94%), resulting in a successful rate of 85.36%. Mediocre recovery was seen in the remaining 36 patients amounting to a 14.64% failure rate. Conclusion: This study showed that ozone disc nucleolysis significantly reduces the pain related to cervical disc herniation along with a significant reduction in disability.

Oxygen–Ozone Therapy of Musculoskeletal Neck Pain: A Review

“…Ghatge et al [ 29 ] in a prospective non-randomized study investigated the role of ozone disc nucleolysis in cervical HD. All VAS and NDI values were significantly lower at 1-year follow-up compared with pre-treatment levels.…”

“…The options for accessing the intervertebral disc differ for the cervical and lumbar spine. While the dorsal oblique paravertebral approach is usually used in the lumbar region, only the right anterolateral approach seems to be safe for cervical discs as the left anterolateral approach is avoided to prevent esophageal injury [ 29 , 42 ]. The O 2 -O 3 mixture can also be applied near the dorsal root ganglion.…”

“…Studies dealing with cervical disc nucleolysis [ 18 , 29 ] utilized the fluoroscopic (plat panel c-arm) guidance. In both studies, the patients were placed in supine position during the needle’s introduction.…”

“…In both studies, the patients were placed in supine position during the needle’s introduction. In the study by Ghatge et al [ 29 ], the needle was introduced through the space between the manually displaced carotid artery and trachea/esophagus. Beyaz and Sayhan [ 18 ] used an anterolateral approach with the introduction of the needle through the larynx and jugular-carotid vessels with laryngeal subluxation.…”

“…This process can be induced in contained discs. On the other hand, in uncontained discs, the nucleus is exposed to the immune system, with antibody-mediated inflammatory reactions leading to resorption and remission of the extruded nucleus by phagocytosis and lysis [ 29 ]. In epidural space, ozone acts as an anti-inflammatory agent modulating and hastening the switch from M1 to M2 macrophages, converting an inflammatory phase to a reparative phase [ 30 ].…”