MR Assessment of Lumbar Disk Herniation Treated with Oxygen-Ozone Diskolysis: The Role of DWI and Related ADC versus Intervertebral Disk Volumetric Analysis for Detecting Treatment Response

Abstract

We prospectively assessed the diagnostic criteria of morphologic MRI study (MMS) and the accuracy of DWI and related ADC values (DWI-ADC) versus intervertebral disk volumetric analysis (IDVA) for predicting shrinkage of lumbar disk herniation treated with oxygen-ozone (O2-O3) diskolysis. Sixty-eight patients (36 men and 32 women; mean age 39) with lumbosciatica underwent O2-O3 diskolysis. The six-month MRI follow-up was performed with FSE-T2 and T2-fat, SE-T1 and DWI-weighted images. IDVA was determined using OsiriX®. Diagnostic criteria and accuracy were evaluated with regards to DWI and related ADC in detecting response to ozone therapy. Fifty-eight of 68 patients had successful outcomes (responders), whereas ten patients showed unsatisfactory outcomes (non-responders). MMS showed that a centrally located herniated disk and grade 1 nerve root compression were more common in the responder group (p < 0.05). DWI-ADC and IDVA showed statistically significant shrinkage in the sixth month of follow-up (p < 0.05) with a mean ADC value reduction of 2.10 × 10−3mm2/s +/− 0.19 SD in the second month of follow-up (p < 0.05). DWI-ADC had an accuracy of 0.81 in detecting response to therapy around the second month of follow-up. DWI-ADC appear to be useful adjuncts to MMS in the follow-up of patients undergoing O2-O3 diskolysis.

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

“…Degenerative disc disease of the spine causing low back pain is a leading cause of morbidity and chronic disability [1]. MRI is the preferred imaging technique to evaluate the degenerative changes of the spine [2,3], showing high sensitivity and specificity in the diagnosis of conditions like disc herniation, spinal stenosis, and spondylodiscitis [4][5][6][7]. In the last years, MRI signal changes in vertebral endplates, especially Modic changes (MC) type I, have been advocated to be a potential specific cause of low back pain [8,9].…”

MRI findings in lumbar spine following O2–O3 chemiodiscolysis: A long-term follow-up

“…Several studies showed a significant correlation between the patient’s age and disc volume changes after ozone–oxygen nucleolysis, 2–5,18 with significant reduction in disc shrinkage in older patients. This is probably a result of a normal age-related process of desiccation of the intervertebral discs, with a reduced direct effect of intradiscal ozone on the release of water molecules from the degenerated nucleus pulposus.…”

“…Besides being the most common cause of lumboradicular pain, it is also the most frequent indication for spine surgery. 1–13…”

Thoracic spine trauma: advanced imaging modality

“…The addition of T2-weighted sequences with fat saturation or STIR sequences is important to highlight bone edema and ligamentous injuries. Other useful sequences include gradient echo T2*weighted images to evaluate the presence of cord hemorrhage [26][27][28][29][30].…”