Minimally invasive treatment for refractory low back pain, targeted by epidural endoscopy with O2/O3 and steroid therapy.
OBJECTIVE
Epidural endoscopy is an efficient option among conservative modalities in the management of refractory low back pain. The purpose of this paper is to evaluate retrospectively the effectiveness of the treatment of this condition with targeted O(2)/O(3) and steroid therapy.


METHODS
The procedures were performed in 32 consecutive patients who failed to show significant response of at least 6 weeks or longer to treatments that included anti-inflammatory and analgesic drugs, physiotherapy and posterior epidural steroids and/or facet joint injections. These procedures were performed during the year 2006 and all the patients have been followed up for at least 2 years.


RESULTS
Patients evaluated by Visual Analogue Scale (VAS) pre and immediately post procedure advised an improvement of mean 80% of their previous pain status. Follow-up revisions with 1, 3, 6, 12 and 24 months showed persistent improvement percentage at mean 60%. The Oswestry Disability Index showed significant changing in status pre and post procedure related to the pain control condition. No serious complications were related to the procedure.


CONCLUSIONS
Targeted Epidural endoscopy associated with injection of O(2)/O(3) and steroids is a safe and efficient minimally invasive procedure to be used in patients with refractory low back pain. The association with ozone (O(2)/O(3)) and steroids seems to result in a long lasting pain relief, giving to the physician and to the patient a wider window to work on the treatment of other frequently associated causes (emotional, socio-economic and environmental) of refractory back pain.
School of Medicine University of Planalto Central and South Lake Hospital, Brasilia, Distrito Federal, Brazil. marcos.masini@uol.com.br
Marcos
M
Masini
Aldo
A
Calaça
D000328:Adult; D004724:Endoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017116:Low Back Pain / Q000188:drug therapy* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D010126:Ozone / Q000627:therapeutic use*; D010147:Pain Measurement; D012189:Retrospective Studies; D013256:Steroids / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
D013256:Steroids; D010126:Ozone