Evaluate the clinical effectiveness of intradiscal Ozone injection combining periradicular injection of Ozone and steroid under CT guidance for the treatment of lumbar disc herniation

Dinh Trung Thanh1,, Do Dinh Tung1, Pham Hong Duc1, Le Minh Truong2
1 Department of Diagnostic Imaging, Saint Paul General Hospital
2 Department of Diagnostic Imaging, 108 Military Hospital

Main Article Content

Abstract

Background: back pain and sciatica caused by disc herniation has a burden upon social activity. The newly minimally invasive technique, percutaneous Ozone (O2-O3) intradisal injection procedure has demonstrated safe and effective in long terms. Purpose: Evaluate the clinical effectiveness of intradiscal Ozone injection combining periradicular injection of Ozone and steroid under CT guidance for the treatment of lumbar disc herniation.


Material and method: Prospective study, 100 patients symtomatic (lumbar pain, sciatica) with mild/moderate lunbar disc bulging or herniation on MRI. The patients were treated with intradiscal Ozone injection combining periradicular injection of Ozone and steroid under CT guidance. Clinical outcomes and MRI images were reviewed to evaluate at 3 months and 6 months. Results: The VAS score and the Oswestry Disability Index (ODI) before and after treatment 3months, 6 months were significant reduction. The mean improvement was 4.7 for VAS and 14 for ODI. All the procedures were technically successful. There were no adverse events associated with the treatment.


Conclusion: Intradiscal injection Ozone treatment of herniated disc is an minimally invasive, easy, safe and effective procedure with low complications and side effects. 

Article Details

References

1. Bejia, I., et al., Factors predicting outcomes of mechanical sciatica: a review of 1092 cases. Joint Bone Spine, 2004. 71 (6): p. 567-71.
2. Nguyen, V.C., Nghiên cứu tác dụng điều trị thoát vị đĩa đệm cột sống thắt lưng của phương pháp tiêm ngoài màng cứng kỹ thuật hai kim. Tạp chí y - dược học quân sự, 2015(2): p. 49-57.
3. Steppan, J., et al., A metaanalysis of the effectiveness and safety of Ozone treatments for herniated lumbar discs. J Vasc Interv Radiol, 2010. 21 (4): p. 534-48.
4. Bocci, V., et al., The usefulness of Ozone treatment in spinal pain. Drug Des Devel Ther, 2015. 9: p. 2677-85.
5. Gallucci M, Limbucci N, Zugaro L, et al. Sciatica: treatment with intradiscal and intraforaminal injections of steroid and oxygen-Ozone versus steroid only. Radiology. 2007;242(3):907-913.
6. Muto, M., et al., Rational approach, technique and selection criteria treating lumbar disk herniations by oxygenOzone therapy. Interv Neuroradiol, 2016. 22 (6): p. 736-740.
7. Leon Fernandez, O.S., et al., Ozone oxidative post-conditioning reduces oxidative protein damage in patients with disc hernia. Neurol Res, 2012. 34 (1): p. 59-67.
8. Gallucci, M., et al., Sciatica: treatment with intradiscal and intraforaminal injections of steroid and oxygen-Ozone versus steroid only. Radiology, 2007. 242 (3): p. 907-13.
9. Magalhaes, F.N., et al., Ozone therapy as a treatment for low back pain secondary to herniated disc: a systematic review and meta-analysis of randomized controlled trials. Pain Physician, 2012. 15 (2): p. E115-29. 10. Oder, B., et al., CT-guided Ozone/steroid therapy for the treatment of degenerative spinal disease--effect of age, gender, disc pathology and multi-segmental changes. Neuroradiology, 2008. 50 (9): p. 777-85.
11. Valat, J.P., et al., Epidural corticosteroid injections for sciatica: a randomised, double blind, controlled clinical trial. Ann Rheum Dis, 2003. 62 (7): p. 639-43.
12. Andreula, C.F., et al., Minimally invasive oxygen-Ozone therapy for lumbar disk herniation. AJNR Am J Neuroradiol, 2003. 24 (5): p. 996-1000. 13. Lehnert, T., et al., Analysis of disk volume before and after CT-guided intradiscal and periganglionic Ozone-oxygen injection for the treatment of lumbar disk herniation. J Vasc Interv Radiol, 2012. 23 (11): p. 1430-6.
14. Perri, M., et al., MRI DWI/ADC signal predicts shrinkage of lumbar disc herniation after O2-O3 discolysis. Neuroradiol J, 2015. 28 (2): p. 198-204. 15. Migliorini, F., et al., Ozone injection therapy for intervertebral disc herniation. Br Med Bull, 2020. 136 (1): p. 88-106.
16. Rimeika G, Saba L, et al., Metanalysis on the effectiveness of low back pain treatment with oxygen-ozone mixture: Comparison between image-guided and non-image-guided injection techniques. Eur J Radiol Open. 2021 Dec 6;8:100389.
17. Bonetti M, Fontana A, Cotticelli B, Volta GD, Guindani M, Leonardi M. Intraforaminal O(2)-O(3) versus periradicular steroidal infiltrations in lower back pain: randomized controlled study. AJNR Am J Neuroradiol. May 2005;26(5):996-1000.
18. Toman, H., et al., Severe headache following Ozone therapy: Pneumocephalus. Agri, 2017. 29 (3): p. 132-136.
19. Andres-Cano, P., et al., Cervical Spondylodiscitis After Oxygen-Ozone Therapy for Treatment of a Cervical Disc Herniation: a Case Report and Review of the Literature. HSS J, 2016. 12 (3): p. 278-283.
20. Gazzeri, R., et al., Fulminating septicemia secondary to oxygen-Ozone therapy for lumbar disc herniation: case report. Spine (Phila Pa 1976), 2007. 32 (3): p. E121-3.