Injection of Intradiscal O2-O3 to Reduce Pain and Disability of Patients With Low Back Pain Due to Prolapsed Lumbar Disk

Hashemi, Masoud; Poorfarokh, Majid; Mohajerani, Seyed Amir; Jalili, Parviz; Akhyani, Vahid; Barikani, Ameneh; Farivar, Farshad

doi:10.5812/aapm.19206

Cited by 22 publications

(26 citation statements)

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“…Ozone chemonucleolysis has been performed for the last 25 years to treat disc herniations with positive results. [13][14][15][16][17][18][19] In the present study the mean VAS among all our patients was 7.5 AE 0.8, which dropped to 6 AE 1.2 (p < 0.001) at one month and 5 AE 1.4 (p < 0.001) at three months after treatment indicating a statistically significant reduction in the pain score. In comparison in a study by Karnalkar et al 16 on 98 patients who were treated with intradiscal injection of oxygen-ozone and intraforaminal steroid the mean VAS score dropped from 8.6 AE 1.34 to 2.7 AE 1.42 at six months after treatment.…”

Section: Discussionmentioning

confidence: 51%

Comparing the results of intradiscal ozone injection to treat different types of intervertebral disc herniation based on MSU classification

2018

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Purpose To evaluate the therapeutic efficacy of intradiscal ozone injection in reducing pain and improving patients’ performance in different types of intervertebral disc herniation based on Michigan State University (MSU) classification. Patients and methods Consecutive patients with low back pain and radiculopathy treated in our center with ozone chemonucleolysis from May 2017 through to January 2018 entered the study. Patients had a disc herniation classified as group 1-A, 2-A, 1-B, 2-B, 1-C, 2-C, 1-AB or 2-AB based on MSU classification in magnetic resonance imaging. In all patients entering the study the severity of pain was recorded according to the visual analog scale criteria before and one and three months after the end of treatment. Oswestry Low Back Pain Disability Index (ODI) was used to compare patients’ performance before and after the treatment. Results In total 128 patients (60 females and 68 males) with mean age of 40.1 ± 10.7 entered the study. The patients were divided into eight groups based on MSU classification each including 16 patients. The reduction of pain severity and ODI score compared to baseline was statistically significant in all groups both in the first month and the third month after treatment. There was also a statistically significant difference between groups regarding the reduction of pain and ODI score indicating significantly worse treatment outcomes in groups 1-C, 2-C and 2-AB. Conclusion Based on our findings it seems that MSU classification can be used in patients’ selection to achieve the best treatment outcome after intradiscal ozone injection among patients with lumbar disc herniation.

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Section: Discussionmentioning

confidence: 51%

Comparing the results of intradiscal ozone injection to treat different types of intervertebral disc herniation based on MSU classification

2018

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“…The TF, compared to IL ESI, are associated with a 12-fold increased risk of intradiscal injection ( 24 ), which can potentially weaken the disc or lead to discitis ( 25 ). Other methods, such as intradiscal ozone injection, have been shown to have a positive effect on disk herniation ( 26 ).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Transforaminal and Parasagittal Epidural Steroid Injections in Patients With Radicular Low Back Pain

et al. 2015

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Background:Epidural steroid injection (ESI), including transforaminal (TF) epidural injections and interlaminar (IL) epidural steroid injections are commonly performed procedures for the management of lumbosacral radicular pain. Parasagittal interlaminar (PIL) approach could enable higher ventral epidural spread, with fewer complications than TF.Objectives:This study aims to compare the effectiveness of PIL and TF ESI in relieving the pain and disability of patients with lumbosacral pain.Patients and Methods:This prospective study enrolled 64 patients, aged between 18 to 75 years, with a diagnosis of low back pain and unilateral lumbosacral radicular pain. The patients were randomized to receive fluoroscopically guided epidural injection, through either the PIL or TF approach. Patients were evaluated for effective pain relief [numerical rating scale (NRS) < 3] by 0 - 10 numeric rating scale (NRS) and functional improvement by the Oswestry Disability Index (ODI).Results:Effective pain relief [numeric rating scale (NRS) < 3] was observed in 77.3% (95% CI: 67‒90.5%) of patients in PIL group and 74.2% (95% CI: 62.4 - 89.4%) of patients in the TF group (P = 0.34), at 4 weeks. Mean NRS score was not significantly different between the PIL group compared to the TF group, at 4 weeks (P = 0.19). Number of patients with improved disability (measured by ODI < 20%) was not significantly different in PIL group (78% of cases) compared to the TF group (76% of cases), at 4 weeks (P = 0.21). There were no adverse effects observed in any of our patients.Conclusions:The PIL epidural injection is as effective as TF epidural injection in improving pain and functional status, in patients with chronic lumbosacral low back pain, due to disc degeneration.

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“…The patients had a reduction of LBP by 43.7% in 6 months followed by 44.0% of improvement in the ODI. Another single group of 30 adult patients with LBP with DH underwent intradiscal injection of O 3 -O 2 mixture (4 mL, 40 µg/mL); the study was done in 2014 by Hashemi et al (2) and a significant amelioration of pain and decrease of the ODI evaluation was noted.…”

Section: Fig 4 Scattering the Correlation Between Dh Reduction And mentioning

confidence: 99%

“…LBP is mostly induced by disc herniation (DH) or degeneration. DH and degeneration have mechanical, biochemical, and inflammatory burdens upon the nerve roots, endanger neurological integrity, and induce radicular pain (1,2).…”

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confidence: 99%

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

et al. 2018

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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

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Injection of Intradiscal O2-O3 to Reduce Pain and Disability of Patients With Low Back Pain Due to Prolapsed Lumbar Disk

Cited by 22 publications

References 13 publications

Comparing the results of intradiscal ozone injection to treat different types of intervertebral disc herniation based on MSU classification

Comparing the results of intradiscal ozone injection to treat different types of intervertebral disc herniation based on MSU classification

Comparison of Transforaminal and Parasagittal Epidural Steroid Injections in Patients With Radicular Low Back Pain

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

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