title: Analysis of disk volume before and after CT-guided intradiscal and periganglionic ozone-oxygen injection for the treatment of lumbar disk herniation.
abstract: OBJECTIVE
  To quantify the change in volume in herniated lumbar disk after computed tomography (CT)-guided intradiscal and periganglionic ozone-oxygen injection and to assess the effects of patient age, sex, and initial disk volume on disk volume changes.
  
  
  METHODS
  A total of 283 patients with lumbar radiculopathy received a single intradiscal (3 mL) and periganglionic (7 mL) injection of an ozone-oxygen mixture (ratio, 3:97; ozone concentration, 30 μg/mL). Under CT guidance, intradiscal and periganglionic injection was performed through an extraspinal lateral approach with a 22-gauge spinal needle. All disk volume changes were evaluated on CT 6 months after the procedure in all patients.
  
  
  RESULTS
  Initial mean disk volume was 17.37 cm(3) ± 4.70 (standard deviation; range, 8.12-29.15 cm(3)). Disk volume reduction (mean, 7.70% ± 5.45; range, 0.29%-22.31%) was seen in 96.1% of treated disks (n = 272) at 6 months after treatment and was found to be statistically significant (P < .0001). In 3.9% of patients (n = 11), disk volume increased (mean, 0.59% ± 0.24; range, 0.11%-0.81%). Patient age correlated negatively with disk volume reduction (r = -0.505; P < .0001) at 6 months after treatment, whereas initial disk volume correlated positively with volume reduction (r = 0.225; P = .00014) after therapy. No correlation was noted between patient sex and disk volume reduction after treatment (P = .09).
  
  
  CONCLUSIONS
  Intradiscal administration of medical ozone is associated with a statistically significant volume reduction of the herniated lumbar disk. The volume-reduction effect of ozone correlates negatively with the patient's age and positively with initial disk volume.
authors.affiliation: Department of Diagnostic and Interventional Radiology, Clinic of Johann Wolfgang Goethe University Frankfurt/Main, Germany. thomas.lehnert@kgu.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Lehnert
authors.forename: Nagy N N
authors.initials: NN
authors.lastname: Naguib
authors.forename: Sebastian
authors.initials: S
authors.lastname: Wutzler
authors.forename: Nour-Eldin A
authors.initials: NE
authors.lastname: Nour-Eldin
authors.forename: Ralf W
authors.initials: RW
authors.lastname: Bauer
authors.forename: Josef Matthias
authors.initials: JM
authors.lastname: Kerl
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Vogl
authors.forename: Joern O
authors.initials: JO
authors.lastname: Balzer
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D007403:Intervertebral Disc / Q000000981:diagnostic imaging / Q000187:drug effects*; D007404:Intervertebral Disc Chemolysis / Q000379:methods*; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging / Q000628:therapy*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000187:drug effects*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010126:Ozone / Q000008:administration & dosage*; D015642:Radiology, Interventional / Q000379:methods*; D012737:Sex Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D010126:Ozone