Percutaneous ozone nucleolysis for lumbar disc herniation

Abstract

PurposeAll percutaneous minimally invasive disc treatments are typically indicated to contained disc herniations. Our study’s aim is to evaluate prospectively the efficacy of ozone nucleolysis in the treatment of either contained or uncontained lumbar disc herniations.MethodsFifty-two patients, aged 27–87 years, with symptomatic herniated lumbar discs, without migration, sequestration, or severe degenerative disc changes, who failed conservative treatment, were included in our study. The patients underwent fluoroscopic-guided intradiscal oxygen-ozone mixture injection (5 ml) at a concentration of 27–30 μg/ml and periradicular injection of the same O2-O3 mixture (10 ml), steroid (1 ml), and local anesthetic (1 ml). Clinical outcomes were evaluated, based on the Oswestry Disability Index (ODI) and pain intensity (0–5) scale results, obtained initially and at 2- and 6-month controls. Our results were analyzed by ANOVA and chi-squared (χ2) tests.ResultsOur initial results obtained at 2-month control were promising, indicating a significant decrease in pain disability and intensity in 74% (37) and 76% (38) of the patients respectively, and minimally increased to 76% (38) and 78% (39) at 6-month control (P < 0.001 and CI 99.9%). The mean preprocedure ODI and pain intensity scores were 35 ± 14.36 and 2.38 ± 0.90, respectively, which were reduced to 19.36 ± 13.12 and 1.04 ± 0.92 at 6-month control. Our failure had been mostly related to long symptoms duration of more than 1 year. No complications were recorded.ConclusionOzone nucleolysis is a safe cost-effective minimally invasive technique for treatment of contained and uncontained lumbar disc herniations.

Ozone therapy with local cellular immune modulation and disc progenitor cell implant is safe, effective and efficient

“…that O 3 therapy is effective to control LBP associated to NP Herniated and/or DDD [34,[39][40][41][42][43][44][45][46][47][48][49]. The two main route of administration used were the intramuscular injection in the paravertebral muscles of the muscles innervated for the nerves of affected segments [39][40][41] and the percutaneous Intra disc injection [42][43][44][45][46][47][48][49]. Both administration route showed effi ciency to control the LBP in around 60 to 80% of treated patients with a diminishing of 60 to 75% in the VAS index.…”

“…The major cause of medical failure was and advanced degree of lumbar-sacrum osteo arthrosis related to a continuous and severe pain that lasted more than one year. Because these morphologic and clinical limitations were described by the fi rst reported treated patients [39][40][41][42][43], these 2 conditions were exclusions in the subsequent series of clinical trials [44][45][46][47][48][49].…”

“…These multifactorial effects of the Oxygen-Ozone therapy are the rational explanation for the high clinical effi cacy on chronic DDD. It is highly effective controlling, and even abolishing, the LBP [39][40][41][42][43][44][45][46][47][48][49]. The limitation of this therapy is that it does not affect fi brosis of the affected area, which is mainly composed of collagen type 1 which inhibits the re growing of new cartilage.…”

Overview on Percutaneous Therapies of Disc Diseases

“…O 2 –O 3 therapy is based on the injection of a mixture of O 2 and O 3 gas inside the nucleus pulposus, in order to reduce the intradiscal pressure, compression on the surrounding structures, and, consequently, associated pain. While withdrawing the needle from its intradiscal position, the gas mixture is often also administered in the soft tissues surrounding the inflamed nerve root (Figure 5) [30,31].…”

“…Percutaneous disk decompression techniques show a pain reduction success rate between 75 and 80%, with long-term stable effects and a significant reduction in the Oswestry disability index (ODI) and visual analogue scale (VAS) values post-procedurally and during follow-up examinations [9,11,14,15,30,32,39,40]: comparative studies among those techniques do not favor one in particular [41,42].…”