Indications and efficacy of O2–O3 intradiscal versus steroid intraforaminal injection in different types of disco vertebral pathologies: a prospective randomized double-blind trial with 517 patients

Perri, Marco; Marsecano, Claudia; Varrassi, Marco; Giordano, Aldo Victor; Splendiani, Alessandra; Cesare, Ernesto Di; Masciocchi, Carlo; Gallucci, M.

doi:10.1007/s11547-015-0598-x

Cited by 26 publications

(46 citation statements)

References 23 publications

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“…The differences encountered from patient to patient on MRI findings may give rise to diagnostic problems in determining the exact cause of pain [15][16][17][18][19], especially in the absence of clear evidence of disc herniation, root compression, or posterior elements involvement. Data from the literature suggest that as many as 80% of patients complaining of low back pain are categorized as having "non-specific low back pain" [9].…”

Section: Discussionmentioning

confidence: 99%

Modic I changes size increase from supine to standing MRI correlates with increase in pain intensity in standing position: uncovering the “biomechanical stress” and “active discopathy” theories in low back pain

et al. 2019

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Purpose To evaluate the relationship between degenerative disc, endplate Modic changes (MC) type I, and pain during upright weight-bearing MRI scan of the lumbar spine in a cohort of patients with non-specific low back pain. Materials and methodsWe evaluated 38 patients with non-specific low back pain and MRI evidence of Modic I vertebral changes. The patients were evaluated in a standard and upright weight-bearing position using a dedicated MR unit. The extent of endplate MC type I, intervertebral disc height at the involved level, and degree of degeneration in the same intervertebral disc were compared. Pain was assessed through the VAS questionnaire. Results In the upright position, the area of Modic I changes increased in 26 patients (68.4%, p ≤ 0.001) compared to the supine position. In the upright position, reduction in the disc height was found in 35 patients (92.1%). Correlation analysis showed moderate negative correlation (ρ = − 0.45) between intervertebral disc height and increase in the area of Modic I changes, and weak positive correlation (ρ = 0.12) between Pfirrmann grade and increase in the area of Modic I changes. At clinical evaluation, 30 patients (78.9%) reported worsening of low back pain standing in the upright position. Increase in VAS values on the upright position correlated significantly (ρ = 0.34) with an increase in the area of Modic I changes. Conclusions Our results showed the modifications of Modic I changes under loading, with MRI evidence of increased MC area extent in the upright position and correlation between Modic changes extension increase and increase in pain in the standing position. Weight-bearing MRI scans represent a valuable complement to standard sequences since they provide the radiologist with additional diagnostic information about low back pain. Graphical abstractThese slides can be retrieved from Electronic Supplementary Material. Key pointsSplendiani A, Bruno F, Marsecano C, Arrigoni F, di Cesare E, Barile A, Masciocchi C (2019) Modic I changes size increase from supine to standing MRI correlates with increase of pain intensity in standing position: uncovering the "biomechanical stress" and "active discopathy" theories in low back pain. Eur Spine J;

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Section: Discussionmentioning

confidence: 99%

Modic I changes size increase from supine to standing MRI correlates with increase in pain intensity in standing position: uncovering the “biomechanical stress” and “active discopathy” theories in low back pain

et al. 2019

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“…The final result consisted of 31 articles 4,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][35][36][37][38][39][40][41][42][43][44] dated from 1969 to 2018, and the examined population was 6843 subjects (Table 1). We did not consider the number of patients treated in the Giurazza et al study 38,40 because being a review, it considered not only intradiscal, but also paravertebral injections. We also decided to cite other authors that described the varied and numerous procedures that are available to the image-guided interventions who may provide these therapies for the spine.…”

Section: Resultsmentioning

confidence: 99%

“…[27][28][29][30][31] Characteristics of Included Articles (Table 1) The review includes three observational retrospective studies, 12,18,23 12 observational prospective stu dies, [13][14][15]19,22,26,[36][37][38]41,43,44 two multicenter pilot studies, 4,10 two case-control studies, 11,16 six randomized controlled trials, 4,8,17,21,24,35,42 one multicenter study 25 two pilot studies, 20,43 one case report, 9 one single arm phase I clinical trial 44 and one review. 40…”

Section: Resultsmentioning

confidence: 99%

“…The technique of intradiscal injection is reported in 31 articles. In 24 studies, 4,9,10,12,14,16,17,20,[22][23][24]26,[35][36][37][38][39][40][41][42][43][44] it is the only treatment while, in the remaining seven studies 11,13,15,18,19,21,25 it is compared to, or in association with, other minimally invasive procedures. (Table 2).…”

Section: Intradiscal Injectionmentioning

confidence: 99%

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<p>The Technique of Intradiscal Injection: A Narrative Review</p>

Migliore¹,

Sorbino²,

Bacciu³

et al. 2020

TCRM

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Background: Low back pain (LBP) is one of the most common spine diseases and represents the most frequent cause of absence from work in developed countries. Approximately 40% of chronic LBP is related to discogenic origin. The goal of the study is producing a review of literature to describe analytically the techniques of intradiscal injections. Methods: PubMed database was searched for clinical studies with the different key terms: "intradiscal", "injection", "steroid" "procedures", "techniques", "CT", "MRI", "fluoroscopy", "fluoroscopic", "guidance", "ozone", "ultrasound", "images". Only studies written in English, French, or Italian in which the intradiscal injection represents the main procedure for the low back discopathy treatment on humans were considered. We excluded the articles that do not mention this procedure; those which indicated that the intradiscal injection had happened accidentally during other treatments; those reporting the patient's pain was determined by other causes than the discopathy (facet joint syndrome, tumor, spondylodiscitis). Results: Thirty-one articles dated from 1969 to 2018 met the criteria. The examined population was 6843 subjects, 52.3% male and 47.7% female, with a mean age of 45.9 ±10.1 years. The techniques are highly variable in terms of procedure: different operators, needle guidance, injection sites, drugs, tilt angle of the needle). Conclusion: The efficacy and the safety of the intradiscal procedures are not easily comparable due to different types of studies and their limited number. Further studies are needed to standardize the intradiscal injection technique/procedure to improve safety, repeatability and effectiveness, and last but not least to reduce peri-and postoperative care and health-care costs.

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“…Oxygen-ozone discolysis is a well-know non-invasive, conservative and alternative treatment proposed for disc herniation; it is meant to produce disc shrinkage through dehydrating and creating a vacuum inside the disc itself. Short, calculated oxidative stress achieved by ozone administration is reported to be able to correct permanent imbalance caused by excessive or chronic oxidative injury [54][55][56]. The procedure performed by expert interventional neuroradiologist can be easily and safely performed under CT guidance and with i.v.…”

Section: Imaging Of Intradiscal O2-o3 Discolysismentioning

confidence: 99%

Imaging of post-operative spine in intervertebral disc pathology

et al. 2017

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This work is an imaging review of spine after surgery with special regard to imaging modality in intervertebral disc pathology. Advances in imaging technology can be evaluated. Depending on the clinical question is asked to the radiologist, it is possible to evaluate post-operative patients with conventional radiology (X-ray), computed tomography and magnetic resonance. Main indications for each technique are analysed. Imaging is important in the diagnosis of many forms of spine pathology and plays a fundamental role in evaluating post-surgical effects of treatments, according to the imaging method which is used, both on spine and on its surrounding tissues (intervertebral discs, spinal cord, muscles and vessels).

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Indications and efficacy of O2–O3 intradiscal versus steroid intraforaminal injection in different types of disco vertebral pathologies: a prospective randomized double-blind trial with 517 patients

Abstract: The addition of O2-O3 discolysis is more effective at 6 months than perigangliar steroid and local anesthetic injection, especially in cases of herniated or protruded discs and with a Grade of Disc Degeneration from mild to moderate range.

Cited by 26 publications

References 23 publications

Modic I changes size increase from supine to standing MRI correlates with increase in pain intensity in standing position: uncovering the “biomechanical stress” and “active discopathy” theories in low back pain

Modic I changes size increase from supine to standing MRI correlates with increase in pain intensity in standing position: uncovering the “biomechanical stress” and “active discopathy” theories in low back pain

<p>The Technique of Intradiscal Injection: A Narrative Review</p>

Imaging of post-operative spine in intervertebral disc pathology

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