Management and Outcome of Ozone Therapy in the Lumbar Spine Disc Disease with and without Use of Corticosteroids
DOI:
https://doi.org/10.36552/pjns.v26i2.695Keywords:
Ozone Chemiodiscolysis, Preganglionic Steroid InjectionAbstract
Objectives: To determine the Consequences and out-turn of ozone with and without the use of peri-ganglionic infiltration of corticosteroids in lumbar spinal generative disc disease.
Material and Methods: Comparative study was conducted in the Neurosurgery Department Pakistan Institute Of Medical Sciences Islamabad from December 2014 to November 2020. We included 338 patients with herniated lumbar disc with backache and radiculopathy. Randomly categorized in groups A and B. Group A was given 4 to 6 ml of intradiscal ozone along with 40 to 80 mg of peri-ganglionic methylprednisolone while group B only received 4 – 6 ml of intra-discal ozone. The visual analog scale was used to assess the degree of pain and modified Macnab criteria were used to assess the post-procedural outcome, periodic follow was carried out up to 6 months after the procedure.
Results: 169 patients were enrolled in group A with 70 females and 90 males. Group B had a total of 169 patents with 89 females and 80 males. In group A, a single procedure was required in 89 patients, twice in 27, and thrice in 10 patients to completely obliterate pain. While in group B, 71 patients had the single procedure, twice in 92 and thrice in patients. Data were compared by the Chi-square test, which was further confirmed by a significant P-value of 0.061.
Conclusion: The combination of percutaneous ozone chemodiscolysis along with the preganglionic injection of steroids as compared to single ozone therapy is the most effective, rapid, and long-lasting method of relieving backache and radiculopathy associated with lumbar disc herniation.
References
Kaye AD, Manchikanti L, Abdi S, Atluri S, Bakshi S, et al. Efficacy of epidural injections in managing chronic spinal Pain: A best evidence synthesis. Pain Physician. 2015; 18: E939-E1004. Hashemi M, Poorfarokh M, Mohajerani.
SA, Jalili P, Akhyani V, Barikani A, Farivar F. Injection of intradiscal O2-O3 to reduce pain and disability of patients with low back pain due to prolapsed lumbar disk. Anesth Pain Med. 2014; 4: e19206.
Thackeray A, Fritz JM, Lurie JD, Zhao W, Weinstein JN. Nonsurgical treatment choices by individuals with lumbar intervertebral disc herniation in the United States: Associations with long-term outcomes. Am J Phys Med Rehabil. 2017; 96: 557-564.
Chung SS, Park CK, Cho KJ, et al. A nationwide retrospective study of opioid management patterns in 2,468 patients with spinal pain in Korea. Asian Spine J. 2016; 10: 1122-1131.
De Oliveira Magalhaes F, Dotta L, Sasse A, 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: E115–E129.
Murphy K, Muto M, Steppan J, et al. Treatment of contained herniated lumbar discs with ozone and corticosteroids: A pilot clinical study. J. Can Assoc Radiol. 2015; 66: 337–384.
Shah MK, Stewart GW. Sacral stress fractures: an unusual cause of low back pain in an athlete. Spine (Phila Pa 1976). 2002; 27: E104-8.
Crockett MT, Moynagh M, Long N, et al. Ozone augmented percutaneous discectomy: A novel treatment option for refractory discogenic sciatica Clin. Radiol. 2014; 69: 1280–1286.
Andreula CF, Simonetti L, De Santis F, Agati R, Ricci R, Leonardi M. Minimally invasive oxygen-ozone therapy for lumbar disk herniation. AJNR Am J Neuroradiol. 2003; 24: 99.
Kilic Mustafa. Ozdemir Buraq et al. Lumbar Intradiscal Ozone Chemonucleolysis applied together with the Epidural Steroid Treatment. Med Bull Sisli Etfal Hosp. 2021; 55 (2): 203–209.
Gianola S, Bargeri S, Del Castillo G, et al. Effectiveness of treatments for acute and subacute mechanical non-specific low back pain: a systematic review with network meta-analysis. Br J Sport Med. 2021; 56 (1): 41-50.
Migliore A, Sorbino A, Bacciu S, et al. The technique of intradiscal injection: a narrative review. Ther Clin Risk Manag. 2020; 16: 953-968.
Magalhaes FN, Dotta L, Sasse A, Teixera MJ, Fonoff ET. 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): E115-E129.
Manchikanti L, Pampati V, Hirsch JA. Retrospective cohort study of usage patterns of epidural injections for spinal pain in the US fee for-service Medicare population from 2000 to 2014. BMJ Open. 2016; 6 (12): e13042.
Helm IS, Harmon PC, Noe C, et al. Trans-foraminal epidural steroid injections: a systematic review and meta-analysis of efficacy and safety. Pain Physician. 2021; 24 (S1): S209-S232.
Krishnan R, Kurup V, Vadivelu N, Dai F, Zhou B, Rajput K. Doeschoice of steroid matter for treatment of chronic low back pain with sacroiliac joint injections: a retrospective study. Curr Pain Headache Rep. 2021; 25 (5): 34.
Dhakal GR, Hamal PK, Dhungana S, Kawaguchi Y. Clinical efficacy of selective nerve root block in lumbar radiculopathy due to disc prolapse. J Nepal Health Res Counc. 2019; 17 (2): 242-246.
Kilic Mustafa. Ozdemir Buraq et all; Lumbar Intradiscal Ozone Chemonucleolysis applied together with the Epidural Steroid Treatment. Med Bull Sisli Etfal Hosp. 2021; 55 (2): 203–209.
Andreula CF, Simonetti L, De Santis F, Agati R, Ricci R, Leonardi M. Minimally invasive oxygen-ozone therapy for lumbar disk herniation. AJNR Am J Neuroradiol. 2003; 24: 99.
Yu Y, Liu W, Song D, et al. Diagnosis of discogenic low back pain in patients with probable symptoms but negative discography. Arch Orthop Trauma Surg. 2012; 132: 627–632.
Downloads
Published
Issue
Section
License
Copyright (c) 2022 Pakistan Journal Of Neurological Surgery
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The work published by PJNS is licensed under a Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). Copyrights on any open access article published by Pakistan Journal of Neurological Surgery are retained by the author(s).
