Ozone Nucleolysis for Management of Pain and Disability in Prolapsed Lumber Intervertebral Disc

The prevalence rate of low back pain in a number of studies ranged from 22% to 65% in one year, and lifetime prevalence ranged from 11% to 84%. Over the years many percutaneous minimally invasive therapeutic modalities have evolved. Intradiscal oxygen-ozone therapy has also showed promising results. We undertook a prospective cohort study to evaluate the therapeutic outcome of oxygen-ozone therapy on patients with lumber disc herniation in the Indian population. After obtaining ethical committee and investigational review board permission, 53 consecutive patients complying with selection criteria were treated with a single session of oxygen-ozone therapy. All presented with clinical signs of lumber nerve root compression supported by CT and MRI findings. All patients received 3–7 ml of ozone-oxygen mixture at an ozone concentration of 29–32 mc/ml of oxygen. Therapeutic outcome was assessed after three weeks, three months, six months, one year and two years on a visual analog scale and Oswestry low back pain disability questionnaire. Pain intensity was significantly reduced following treatment (VAS baseline 7.58 ± 0.86, after three weeks 2.75 ± 1.42 and after two years 2.64 ± 2.14). Similarly the Oswestry disability index showed a remarkable improvement in the functional status of the patients (p<0.05). No major complication was observed in this case series. Oxygen-ozone treatment is highly effective in relieving low back pain due to lumber disc herniation.

Download Full-text

Ozone injection therapy for intervertebral disc herniation

British Medical Bulletin ◽

10.1093/bmb/ldaa032 ◽

2020 ◽

Vol 136 (1) ◽

pp. 88-106

Author(s):

Filippo Migliorini ◽

Nicola Maffulli ◽

Jörg Eschweiler ◽

Marcel Bestch ◽

Markus Tingart ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Disc Herniation ◽

Lumbar Disc ◽

Current Evidence ◽

Intervertebral Disc Herniation ◽

Low Back ◽

Ozone Therapy ◽

Ozone Injection

Abstract Introduction Lumbar disc herniation (LDH) is a common cause of low back pain (LBP). Recently, in the setting of LBP caused by LDH, a growing interest in ozone therapies has been observed. Source of data Recent published literatures. Areas of agreement Being low back pain more common in the elderlies, exploring conservative alternatives to the surgical intervention is of especial interest. Areas of controversy Efficacy and feasibility of ozone injections for LDH is debated. Several clinical studies showed controversial results, and the true benefit has not yet been clarified. Growing points Systematically summarize current evidences, analyze the quantitative available data and investigate the role of percutaneous ozone therapy for LDH. Areas timely for developing research Current evidence encourage the use of ozone therapy for LBP from LDH. These conclusions should be interpret in light of the limitations of the present study.

Download Full-text

Implication of Two Different Doses of Intradiscal Ozone-Oxygen Injection upon the Pain Alleviation in Patients with Low Back Pain: A Randomized, Single-Blind Study

January 2018 - Pain Physician ◽

10.36076/ppj.2018.1.e25 ◽

2018 ◽

Vol 1 (21;1) ◽

pp. E25-E31 ◽

Cited By ~ 2

Author(s):

Emad Zarief Kamel

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Disc Herniation ◽

Blind Study ◽

Pain Clinic ◽

Oxygen Mixture ◽

Low Back ◽

Intradiscal Injection ◽

Single Blind ◽

Different Doses

Background: Low back pain (LBP) is mostly induced by disc herniation (DH) or degeneration and has a burden upon social activity and economical aspects of life. An abundance of medical and surgical interventions have evolved to resolve this problem, but one of the newly introduced techniques, which is the minimally invasive, low cost ozone-oxygen mixture (O3 -O2 ) intradiscal injection, offers a rapid onset amelioration of symptoms with a sustained duration of pain relief. Objective: We aim to evaluate the quality of pain alleviation using 2 different doses of intradiscal injections of O3 -O2 mixture. Study Design: A prospectively randomized, single-blind study. Setting: Pain clinic, anesthesia, intensive care, and pain department in Assiut University Hospitals. Methods: Sixty patients with symptomatizing single lumbar DH were subjected to O3 -O2 intradiscal injection and randomly allocated into one of 2 groups; group A: received 10 mL, 40 µg/ mL of O3 -O2 and group B: received 10 mL, 30 µg/mL of O3 -O2 . Pain score and functional ability of the patients using the visual analog scale (VAS) and Oswestry Disability Index (ODI) were evaluated after 1, 6, and 12 months and compared to the basal values. Patient satisfaction and reduction of DH were evaluated after the sixth month. Results: There were no significant differences between the 2 groups regarding the clinical outcome; however both the ODI and VAS evaluations showed highly significant improvement (decreased) (P < 0.01) after injection and during the entire follow-up period. There were highly significant negative correlations between the DH reduction percentage and both the VAS and ODI scores after 6 months in both of the groups. Limitations: This study was limited by a small sample size; it was also an active control trial, which may explain the insignificant difference in between the groups, in addition to being a singleblind trial. Conclusion: Intradiscal injection of O3 -O2 mixture is a very valuable maneuver in the reduction of DH size and improvement of pain quality, with either ozone concentrations of 40 µg/mL or 30 µg/mL. Key words: Low back pain, ozone, disc herniation

Download Full-text

Efficacy of antibiotic treatment in patients with chronic low back pain and Modic changes (the AIM study): double blind, randomised, placebo controlled, multicentre trial

BMJ ◽

10.1136/bmj.l5654 ◽

2019 ◽

pp. l5654 ◽

Cited By ~ 13

Author(s):

Lars Christian Haugli Bråten ◽

Mads Peder Rolfsen ◽

Ansgar Espeland ◽

Monica Wigemyr ◽

Jörg Aßmus ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Antibiotic Treatment ◽

Disc Herniation ◽

Chronic Low Back Pain ◽

Modic Changes ◽

Low Back ◽

Double Blind ◽

The Difference ◽

One Year

Abstract Objective To assess the efficacy of three months of antibiotic treatment compared with placebo in patients with chronic low back pain, previous disc herniation, and vertebral endplate changes (Modic changes). Design Double blind, parallel group, placebo controlled, multicentre trial. Setting Hospital outpatient clinics at six hospitals in Norway. Participants 180 patients with chronic low back pain, previous disc herniation, and type 1 (n=118) or type 2 (n=62) Modic changes enrolled from June 2015 to September 2017. Interventions Patients were randomised to three months of oral treatment with either 750 mg amoxicillin or placebo three times daily. The allocation sequence was concealed by using a computer generated number on the prescription. Main outcome measures The primary outcome was the Roland-Morris Disability Questionnaire (RMDQ) score (range 0-24) at one year follow-up in the intention to treat population. The minimal clinically important between group difference in mean RMDQ score was predefined as 4. Results In the primary analysis of the total cohort at one year, the difference in the mean RMDQ score between the amoxicillin group and the placebo group was −1.6 (95% confidence interval −3.1 to 0.0, P=0.04). In the secondary analysis, the difference in the mean RMDQ score between the groups was −2.3 (−4.2 to−0.4, P=0.02) for patients with type 1 Modic changes and −0.1 (−2.7 to 2.6, P=0.95) for patients with type 2 Modic changes. Fifty patients (56%) in the amoxicillin group experienced at least one drug related adverse event compared with 31 (34%) in the placebo group. Conclusions In this study on patients with chronic low back pain and Modic changes at the level of a previous disc herniation, three months of treatment with amoxicillin did not provide a clinically important benefit compared with placebo. Secondary analyses and sensitivity analyses supported this finding. Therefore, our results do not support the use of antibiotic treatment for chronic low back pain and Modic changes. Trial registration ClinicalTrials.gov NCT02323412 .

Download Full-text

Mechanism of Action of Oxygen Ozone Therapy in the Treatment of Disc Herniation and Low Back Pain

Advances in Minimally Invasive Surgery and Therapy for Spine and Nerves - Acta Neurochirurgica Supplementum ◽

10.1007/978-3-211-99370-5_19 ◽

2010 ◽

pp. 123-125 ◽

Cited By ~ 13

Author(s):

Emma Borrelli

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Disc Herniation ◽

Mechanism Of Action ◽

Low Back ◽

Ozone Therapy

Download Full-text

Effectiveness of Paravertebral Ozone Therapy in Individuals with Low Back Pain with or without Radicular Pain: A Systematic Review

10.29011/2576-957x.100028 ◽

2020 ◽

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Radicular Pain ◽

Low Back ◽

Ozone Therapy

Download Full-text

Rasterstereographic Analysis of Lateral Shift in Patients with Lumbar Disc Herniation: A Case Control Study

Advances in Orthopedics ◽

10.1155/2018/6567139 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8

Author(s):

Britta K. Krautwurst ◽

Jürgen R. Paletta ◽

Sylvia Mendoza ◽

Adrian Skwara ◽

Melvin Mohokum

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Pain Intensity ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Pelvic Tilt ◽

Lumbar Disc ◽

Lateral Shift ◽

Healthy Controls ◽

Low Back

Objective. Detection of a lateral shift (LS) in patients with diagnosed disc herniation compared to healthy controls. Summary of Background Data. A specific lateral shift (LS) pattern is observed in patients with disc herniation and low back pain, as shown in earlier studies. Methods. Rasterstereography (RS) was used to investigate the LS. Thirty-nine patients with lumbar disc herniation diagnosed by radiological assessment and low back pain and/or leg pain (mean age 48.2 years, mean BMI 28.5, 28 males and 11 females) and 36 healthy controls (mean age 47.4 years, mean BMI 25.7, 25 males and 11 females) were analysed. LS, pelvic tilt, pelvic inclination, lordotic angle, and trunk torsion were assessed. Results. The patient group showed a nonsignificant increase in LS, that is, 5.6 mm compared to the healthy controls with 5.0 mm (p = 0.693). However, significant differences were found between groups regarding pelvic tilt in degrees (patients 5.9°, healthy controls 2.0°; p = 0.016), trunk torsion (patients 7.5°, controls 4.5°; p = 0.017), and lordotic angle (patients 27.5°, healthy controls 32.7°; p = 0.022). The correlation between pain intensity and the FFbH-R amounted 0.804 (p = < 0.01), and that between pain intensity and the pain disability index was 0.785 (p < 0.01). Discussion. Although some studies have illustrated LS with disc herniation and low back pain, the present findings demonstrate no significant increase in LS in the patient group compared to healthy controls. Conclusion. The patients with lumbar disc herniation did not demonstrate an increased LS compared to healthy controls. Other parameters like pelvic tilt and inclination seemed to be more suitable to identify changes in posture measured by RS in patients with low back pain or disc herniation.

Download Full-text

HUBUNGAN ANTARA KADAR LIPID DARAH DENGAN DERAJAT HERNIASI DISKUS INTERVERTEBRALIS

Majalah Kedokteran Neurosains Perhimpunan Dokter Spesialis Saraf Indonesia ◽

10.52386/neurona.v36i2.66 ◽

2019 ◽

Vol 36 (2) ◽

Author(s):

Elsa Ana Purika ◽

Susi Aulina ◽

Audry Devisanty Wuysang ◽

Andi Alfian Zainuddin

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Total Cholesterol ◽

Disc Herniation ◽

Serum Lipid ◽

Low Back ◽

Spearman Correlation ◽

Lipid Levels ◽

Serum Lipid Levels ◽

Vertebral Disc

THE CORRELATION BETWEEN SERUM LIPID LEVELS WITH THE SEVERITY OF INTER-VERTEBRAL DISC HERNIATIONABSTRACTIntroduction: Inter-vertebral Disc Herniation (IDH) is one of the common causes of low back pain (LBP). High level of blood lipids is a risk factor for atherosclerosis, and responsible as the cause of decreased blood supply to the intervertebral discs which basically has minimal vascularization, thus, it is estimated that there is a relationship between blood lipid levels and IDH.Aim: To identify the correlation between serum lipid levels with the severity of IDH.Methods: Clinical trials with cross sectional designs were carried out on subjects with IDH during April to June 2018 in Dr. Wahidin Sudirohusodo Hospital, Makassar. Serum lipid levels (HDL, LDL, triglyceride and total cholesterol) were examined and the degree of disc herniation (1 to 4) was assessed. Data analyzed using the Spearman correlation test.Results: In this study there were 40 subjects, 15 males and 25 females, with mean age 50.75 (30-62) years old. Most patients were found with degrees of IDH 2 and 3 (total 75%). The Spearman correlation test showed that there was a negative correlation between HDL with degrees of IDH, as well as a positive correlation between LDL and triglycerides with degrees of IDH, but there was no correlation between total cholesterol levels with degrees of IDH.Discussion: The lower the HDL level, the higher the degree of IDH. On the other hand, the higher the level of LDL and triglycerides, the higher the degree of IDH.Keywords: Inter-vertebral disc herniation, low back pain, serum lipid levelsABSTRAKPendahuluan: Herniasi diskus intervertebralis (HDI) merupakan salah satu penyebab nyeri punggung bawah (LBP) yang cukup sering terjadi. Tingginya kadar lipid darah merupakan faktor risiko untuk aterosklerosis, dan bertanggung jawab sebagai penyebab menurunnya suplai darah pada diskus intervertebralis yang pada dasarnya sudah minim vaskularisasi, sehingga diperkirakan terdapat hubungan antara kadar lipid darah dengan penyakit degenerasi diskus intervertebralis.Tujuan: Mengetahui hubungan antara kadar lipid darah dengan derajat herniasi diskus intervertebralis.Metode: Penelitian potong lintang terhadap subjek dengan herniasi diskus intervertebralis yang berobat ke RSUP Dr. Wahidin Sudirohusodo, Makassar, selama bulan April-Juni 2018. Dilakukan penilaian kadar lipid darah (HDL, LDL, trigiliserida, dan kolesterol total) serta derajat herniasi diskus intervertebralis (1 sampai 4) berdasarkan gejala klinis dan gambaran MRI. Analisis data menggunakan uji korelasi Spearman.Hasil: Didapatkan 40 subjek yang terdiri atas 15 orang laki-laki dan 25 orang perempuan dengan rerata usia 50,75 (30–62) tahun. Mayoritas subjek mengalami HDI derajat 2 dan 3 (total 75%). Uji korelasi Spearman menunjukkan adanya korelasi negatif antara kadar HDL dengan derajat HDI, serta korelasi positif antara kadar LDL dan trigliserida dengan derajat HDI, namun tidak terdapat korelasi antara kadar kolesterol total dengan derajat HDI.Diskusi: Semakin rendah kadar HDL, maka semakin berat derajat HDI. Sebaliknya semakin tinggi kadar LDL dan trigliserida, maka semakin berat derajat HDI.Kata kunci: Herniasi diskus intervertebralis, kadar lipid darah, nyeri punggung bawah

Download Full-text