Acute prevertebral abscess secondary to intradiscal oxygen–ozone chemonucleolysis for treatment of a cervical disc herniation

Abstract

ObjectiveWe herein present a case involving a prevertebral abscess complicated by a spinal epidural abscess (SEA) secondary to intradiscal oxygen–ozone chemonucleolysis for treatment of a cervical disc herniation.MethodsA 67-year-old woman with a history of intradiscal oxygen–ozone chemonucleolysis developed numbness and weakness in her right upper and bilateral lower extremities followed by urinary retention. Her symptoms did not respond to intravenous antibiotics alone. Magnetic resonance imaging of the cervical region revealed an extensive SEA anterior to the spinal cord, spinal cord myelopathy due to anterior compression by the lesion, and a prevertebral abscess extending from C2 to T1. She underwent surgical drainage and irrigation.ResultsThe patient was successfully treated with surgical drainage and systemic antibiotic therapy without kyphosis. Streptococcus intermedius was detected within the abscess. All clinical symptoms except for the sensory deficit in the left leg were relieved.ConclusionsThe safety of intradiscal oxygen–ozone therapy requires further assessment. High-dose intravenous antibiotics should be initiated empirically at the earliest possible stage of prevertebral and epidural abscesses. Surgical drainage may be a rational treatment choice for patients with a prevertebral abscess complicated by an SEA and spinal cord myelopathy.

Percutaneous Computed Tomography-Guided Oxygen-Ozone (O2O3) Injection Therapy in Patients with Lower Back Pain—An Interventional Two-Year Follow-Up Study of 321 Patients

“…While generally considered safe with low rates of complications and adverse events, the treating physician should still keep in mind that severe complications after percutaneous application of oxygen-ozone can still occur in rare cases. Among others, such complications can comprise allergic reactions, spinal cord or nerve injury, the formation of prevertebral abscesses, air embolism, and cardiopulmonary arrest with pneumoencephaly [48][49][50][51].…”

Mycobacterium tuberculosis Infection of the Spine Secondary to Oxygen – Ozone Therapy for Prolapse Intervertebral Disc: A Scoping Review

“…At present, there are only a few studies advocating the use and effectiveness of ozone therapy in herniated disc [ 1 , 3 , 4 , 5 , 6 , 7 ]. There are a scarce case reports depicting the secondary complications after its use even on extensive literature search [ 2 , 8 , 9 , 10 , 11 , 12 , 13 ]. The various non-infectious complications ( Table 1 ) reported are the bilateral vitreoretinal hemorrhages after the use of oxygen ozone therapy for lumbar disc herniations [ 10 ].…”

“…There is also one reported death due to gas embolism by ozone therapy given by auto-hemotransfusion [ 9 ]. Till date, there are only six individual reports of infectious ( Table 2 ) complications published in literature [ 2 , 8 , 11 , 12 , 13 , 14 ]. Gazzeri et al reported a case of iliopsoas abscess secondary to Escherichia coli infection.…”

Updated Review on Ozone Therapy in Pain Medicine

“…However, some other complications have been reported in the literature, most of them due to malpractice or without a causal relationship between the ozone administration and the adverse event ( Marchetti and La Monaca, 2000 ; Corea et al, 2004 ; Lo Giudice et al, 2004 ; Ginanneschi et al, 2006 ; Gazzeri et al, 2007 ; Bo et al, 2009 ; Seyman et al, 2012 ; Vilas-Rolan et al, 2012 ; Fort et al, 2014 ; Menéndez et al, 2014 ; Mustafa et al, 2015 ; Vanni et al, 2015 ; Cano et al, 2016 ; Salvatore et al, 2016 ; Balan et al, 2017 ; Hüseyin et al, 2017 ; Wen-Juan et al, 2017 ; Beyaz et al, 2018 ; Yang et al, 2018 ; He et al, 2019 ). Most of them disappeared in a few days not needing specific medical treatment.…”