Minimally invasive oxygen-ozone therapy for lumbar disk herniation.
OBJECTIVE
Oxygen-ozone therapy is a minimally invasive treatment for lumbar disk herniation that exploits the biochemical properties of a gas mixture of oxygen and ozone. We assessed the therapeutic outcome of oxygen-ozone therapy and compared the outcome of administering medical ozone alone with the outcome of medical ozone followed by injection of a corticosteroid and an anesthetic at the same session.


METHODS
Six hundred patients were treated with a single session of oxygen-ozone therapy. All presented with clinical signs of lumbar disk nerve root compression, with CT and/or MR evidence of contained disk herniation. Three hundred patients (group A) received an intradiscal (4 mL) and periganglionic (8 mL) injection of an oxygen-ozone mixture at an ozone concentration of 27 micro g/mL. The other 300 patients (group B) received, in addition, a periganglionic injection of corticosteroid and anesthetic. Therapeutic outcome was assessed 6 months after treatment by using a modified MacNab method. Results were evaluated by two observers blinded to patient distribution within the two groups.


RESULTS
A satisfactory therapeutic outcome was obtained in both groups. In group A, treatment was a success (excellent or good outcome) in 70.3% and deemed a failure (poor outcome or recourse to surgery) in the remaining 29.7%. In group B, treatment was a success in 78.3% and deemed a failure in the remaining 21.7%. The difference in outcome between the two groups was statistically significant (P <.05).


CONCLUSIONS
Combined intradiscal and periganglionic injection of medical ozone and periganglionic injection of steroids has a cumulative effect that enhances the overall outcome of treatment for pain caused by disk herniation. Oxygen-ozone therapy is a useful treatment for lumbar disk herniation that has failed to respond to conservative management.
Department of Neuroradiology, Ospedale Bellaria, Bologna, Italy.
Cosma F
CF
Andreula
Luigi
L
Simonetti
Fabio
F
De Santis
Raffaele
R
Agati
Renata
R
Ricci
Marco
M
Leonardi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005727:Ganglia, Spinal; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007278:Injections, Spinal; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging / Q000628:therapy*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008775:Methylprednisolone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000077555:Methylprednisolone Acetate; D008875:Middle Aged; D010100:Oxygen / Q000008:administration & dosage*; D010126:Ozone / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D000077555:Methylprednisolone Acetate; D010126:Ozone; D010100:Oxygen; D008775:Methylprednisolone; D002045:Bupivacaine