Abstract
Purpose
This paper describes discolysis by intradiscal, periganglionic and periradicular oxygen-ozone (O2-O3) injection, a minimally invasive percutaneous technique for the treatment of lumbar disk herniation.
Materials and methods
From June 2000 to December 2006, we performed O2-O3 chemonucleolysis procedures in 2,900 patients affected by lumbar disk herniation. Patients were selected on the basis of clinical, psychological, neurological and neuroradiological criteria. Exclusion criteria were extruded hernia and/or free disc fragments, hyperalgesic-paralysing sciatica and progressive neurological impairment of the affected limb. All percutaneous treatments were performed under computed tomography (CT) guidance. All patients were evaluated after 1 month, and those showing only partial success were scheduled for a second treatment session.
Results
Results were evaluated with the modified MacNab classification, the visual analogue scale and the Oswestry Disability Index at 6 and 12 months. Success rates were 75%–80% for soft disc herniation, 70% for multiple-disc herniations and 55% for failed back surgery syndrome. None of the patients suffered early or late neurological or infectious complications.
Conclusions
According to our data, minimally invasive percutaneous treatment by intradiscal, periradicular or periganglionic O2-O3 infiltration is a valuable and competitive technique that provides excellent results at low cost and without complications.
Riassunto
Obiettivo
Illustrare la tecnica mini-invasiva percutanea di infiltrazione di ossigeno-ozono (chemiodiscolisi con miscela di O2-O3) intradiscale, perigangliare e periradicolare per il trattamento delle ernie del disco lombari.
Materiali e metodi
Dal giugno 2000 al dicembre 2006 sono state eseguite 2900 procedure di infiltrazione di O2-O3 in pazienti affetti da ernia discale lombare. Tutti i pazienti sono stati selezionati secondo criteri clinici, psicologici, neurologici e neuroradiologici. I criteri di esclusione sono stati: ernia discale espulsa e/o frammento erniario libero, grave deficit motorio dell’arto e/o disturbi sfinterici, sciatalgia iperalgica, deficit neurologico progressivo dell’arto interessato. La tecnica percutanea è stata sempre eseguita sotto guida TC. Tutti i pazienti sono stati valutati a distanza di un mese dal primo trattamento e sottoposti a un secondo trattamento percutaneo in caso di successo parziale.
Risultati
I risultati sono stati valutati secondo la scala di “Mac Nab modificata”, secondo la “Visual Analogyc Scale” (VAS) e “Oswestry Disability Scale” (ODS) a sei e dodici mesi con un successo variabile tra il 75% e l’80% per le ernie discali molli; 70% per le ernie discali multiple e 55% per la sindrome da fallimento chirurgico (FBSS). Non è stata riportata nessuna complicanza neurologica o infettiva nel breve o lungo follow-up.
Conclusioni
Secondo la nostra casistica, il trattamento percutaneo mini-invasivo con infiltrazione di O2-O3 intradiscale e periradicolare risulta essere un’alternativa valida e competitiva rispetto alle altre tecniche percutanee garantendo un ottimo risultato terapeutico in termini percentuali, a basso costo, facilmente ripetibile e in assenza di complicanze.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References/Bibliografia
Long MD (1991) Decision making in lumbar disc disease. Clinical Neurosurg 39:36–51
Muto M, De Maria G, Izzo R et al (1997) Nondiscal lumbar radiculopathy: combined approach by CT and MR. Riv Neuroradiol, 10:165–173
Bush K, Cowan N, Katz DE et al (1992) The natural history of sciatica associated with disc pathology. A prospective study with clinical and independent radiologic followup Spine, 17 (10):1205–1
Gangi A, Dietemann JL, Mortazavi R et al (1998) CT-guided interventional procedures for pain management in the lumbosacral spine. Radiographics, 18(3):621–33
Gallucci M, Splendiani A, Ma sciocchi C (1997) Spine and spinal cord: neuroradiological funcional anatomy Riv Neuroradiol, 11:293–304
Von Tulder MW, Koes BW, Bouter LM (1997) Conservative treatment of acute and chronic non-specific low back pain.Spine, 22:2128–2156
Saal J (1995) The role of inflammation in lumbar spine Spine, 20:1821–1827
Onik GM (2000) Percutaneous diskectomy in the treatment of herniated lumbar disks. Neuroimaging Clin N Am.10(3):597–607
Muto M (2004) Alterazioni indotte da infiltrazioni intradiscali e intramuscolari di ossigeno-ozono: studio anatomo-patologico.Risultati preliminari. Riv. Italiana di Ossigeno-Ozonoterapia 3:7–13
Smith L (1964) Enzyme dissolution of the nucleus pulposus in humans Jama 11; 187:137–40
Nordby EJ, Wright PH, Schofield SR (1993) Safety of chemonucleolysis. Adverse effects reported in the United States 1982–1991 Review. Clin Orthop Relat Res. 293:122–34
Gibby W (2002) Automated percutaneous discectomy. In: Williams AL, M FR, Editors. Handbook of diagnostic and theurapeutic spine procedures. St. Liouis: Mosby: 203–225
Choy DS (2004) Percutaneous laser disc decompression: a 17-year experience. Photomed Laser Surg. Oct; 22(5):407–10. Review
Gibson JNA, Grant IC, Waddell G (2003) Surgery for lumbar disc prolapse (Cochrane Review). In The Cochrane Library. Oxford: Update Software.: Issue 2
Saal JA, Saal JS (2000) Intradiscal electrothermal treatment for chronic discogenic low back pain: a prospective outcome study with minimum 1-year follow-up. Spine.25(20):2622–7
Eckel TS (2002) Intradiscal electrothermal therapy. In Williams AL, Murtagh FR, Editors.Handbook of diagnostic and theurapeutic spine procedures. St. Louis: Mosby.:229–244
Vijay S, M.D., et al (2002) Percutaneous Disc Decompression Using Coblation (NucleoplastyTM) in the Treatment of Chronic Discogenic Pain. Pain Physician, 5(3):250–259
Sharps L (2002) Percutaneous Disc Decompression Using Nucleoplasty Pain Physician., 5(2):121–126
Kenneth M, Robert E (2004) Percutaneous lumbar discectomy: clinical response in an initial cohort of fifty consecutive patients with chronic radicular pain. Pain Pract, 4:19–27
Amoretti N, Huchot F, Flory P et al (2005) Percutaneous nucleotomy: preliminary communication on a decompression probe (Dekompressor) in percutaneous discectomy. Ten case reports. Clin Imaging, 29:98–101
Andreula C, Muto M, Leonardi M (2004) Interventional spinal procedures. Eur J Radiol., 50(2):112–9. Review
Muto M, Andreula C, Leonardi M (2004) Treatment of herniated lumbar disc by intradiscal and intraforaminal oxygen-ozone (O2-O3) injection J Neuroradiol., 31(3),183–9
Andreula CF, Simonetti L, De Santis F et al (2003) Minimally invasive oxygen-ozone therapy for lumbar disk herniation. AJNR 24:996–1000
Muto M, Avella F (1998) Percutaneous treatment of herniated lumbar disk by intradiscal oxygen-ozone injection. Intervent Neuroradiol 4:279–286
Tian JL et al (2007) Changes of CSF and spinal pathomorphology after hightconcentration ozone injection into the subarachnoid space:an experimental study in pigs. AJNR 28:1051–54
Iliakis E (1995) Ozone treatment in low bak pain. Orthopaedics 1:29–33
Fabris G, Tommasini G, et al (1999) Oxygen-ozone therapy in percutaneous treatment of lumbar HNP. Riv Neuroradiol, 12 [suppl 4]:23
D’Erme M, Scarchilli A et al (1999) Ozone therapy in lumbar sciatic pain. Radiol Med, 95 (1–2):21–24
Bocci V. Ossigeno-ozonoterapia. Comprensione dei meccanismi di azione e possibilità terapeutiche. Milano: Ambrosiana 2000
Bonetti M, Cotticelli B et al (2000) Oxygen-ozone therapy vs epidural steroid injection. Riv Neuroradiol.13:203–206
Leonardi M, Barbara C et al (2001) Percutaneous treatment of lumbar herniated disk with intradiscal injection of ozone misture. Riv Neuroradiol, 14 [suppl 1]:51–53
Andreula C (2002) Lumbar herniated disk and degenerative changes. Interventional spinal treatment with chemiodiscolysis with nucleoptesis with 03 and perigangliar infiltration in 150 cases. Riv Neuroradiol, 14 (suppl 1):81–88
Andreula C, Leonardi M (2002) Chemiodiscolysis and periradicular and periganglionic infiltration with oxygenozone in disk herniation. State of art. In Spine Imaging and Image-Guided. Intervention. Oak Brook, IL American Society of Spine Radiology
Wilco CP, van Houwelingen H et al (2007) Surgery versus Prolonged Conservative Treatment for Sciatica, for the Leiden-The Hague Spine Intervention Prognostic Study Group* The new england journal of medicine vol 356 n. 22 pp. 2245–56
Andreula C (2005) Interventional Spinal procedures Riv. Neurorad. 18/Sup.2:71–74
Gallucci M, Limbucci N, Masciocchi C et al (2007) Sciatica: Treatment with Intradiscal and Intraforaminal Injections of Steroid and Oxygen-Ozone versus Steroid Only Radiology: Vol. 242(3):907–17
Bonetti M, Leonardi M et al (2005) Intraforaminal O2-O3 versus Periradicular Steroidal Infiltrations in Lower Back Pain:Randomized Controlled AJNR 26:996–1000
Muto M et al (2003) L’insuccesso terapeutico nel trattamento con O2-O3 intradiscaleintraforaminale nei conflitti disco-radicolari. Riv. Neuroradiologia 16 suppl. 1:82–84
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Muto, M., Ambrosanio, G., Guarnieri, G. et al. Low back pain and sciatica: treatment with intradiscal-intraforaminal O2-O3 injection. Our experience. Radiol med 113, 695–706 (2008). https://doi.org/10.1007/s11547-008-0302-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11547-008-0302-5