MRI findings in lumbar spine following O<sub>2</sub>–O<sub>3</sub> chemiodiscolysis: A long-term follow-up

Bruno, Federico; Smaldone, Fernando; Varrassi, Marco; Arrigoni, Francesco; Cesare, Ernesto Di; Masciocchi, Carlo; Splendiani, Alessandra

doi:10.1177/1591019917703784

Cited by 21 publications

(13 citation statements)

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“…The grading system for bone marrow changes near the endplate was implemented by Modic et al who gave MRI definitions of such alterations [8,20,29]. The etiopathogenesis of Modic changes type I is still a matter of debate [20,30,31].…”

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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“…[ 8 ] Similarly, a significant volume reduction was detected in the 6-month assessment of 283 patients with CT.[ 19 ] Muto et al showed a 63% reduction in disk volume at month 18 while Bruno et al reported a significant volume reduction at year 3. [ 12 , 20 ] Due to the design of our study, evaluation of the disc volumes could not be done for the patients in our study but our serendipitous clinical observations confirmed this effect.…”

Section: Discussionmentioning

confidence: 83%

Lumbar Intradiscal Ozone Chemonucleolysis applied together with the epidural steroid treatment

et al. 2020

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Objectives: Intradiscal ozone treatment is a minimally-invasive method that can be applied to patients who have low back pain and do not respond to conservative treatment. This retrospectively designed study aimed to evaluate its clinical efficacy, adverse effects, or complication rates. Methods: Patients with lumbar degenerative disc disease (LDDD) who underwent intradiscal O 2 -O 3 treatment between January 2016 and April 2018 were included in the study. Pain and disability levels were assessed at pre-injection, 1-month and 1-year post-injection periods using visual analog scale (VAS) and Oswestry Disability Index (ODI), respectively. Results: A total of 520 patients (270 males and 250 females) with the mean age of 38.9±5.7 years included in the study. First-month and 1st-year post-injection VAS and ODI scores were significantly lower than pre-injection scores (p<0.001). Remarkable VAS score reduction (more than 50%) was found in 60.2% of patients at 1st month and in 52.9% of patients at the 1st year. No important side effects recorded. Conclusion: Intradiscal ozone therapy applied together with the epidural steroid treatment, one of the percutaneous application techniques for the treatment of low back pain related to LDDD, has successful outcomes, clinical efficacy, and low rate of side effects, and thus, is one of the methods that should be considered before surgery when appropriate patients.

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“…Moreover, pain relief can be accompanied by a shrinkage or disappearance of the bulging herniated disc responsible for nerve root compression, which has been evaluated in studies via MRI checking with no acceleration of the disc degeneration process in long-term follow-up. 17 – 21 …”

Section: Discussionmentioning

confidence: 99%

Comparison of percutaneous intradiscal ozone injection with laser disc decompression in discogenic low back pain

Rahimzadeh¹,

Imani²,

Ghahremani³

et al. 2018

JPR

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BackgroundIntervertebral disc herniation with the pressure on the surrounding neural structures is one of the most important causes of chronic low back pain, which sometimes leads to open surgery. Reducing the pressure inside the disc with intradiscal intervention such as laser irradiation or ozone injection is a minimally invasive method and an alternative to surgery with satisfactory results. These two methods were compared with each other in this research.Patients and methodsIn this clinical trial, 40 patients with back pain radiating to lower limb due to lumbar intervertebral disc herniation were selected. These patients were randomly divided into two equal groups for percutaneous intradiscal intervention. The Laser Disc Decompression Group (LDG) (n=20) was exposed to 1500 J of laser irradiation into the disc center. In the Ozone Injection Group (OZG) patients (n=20), 6 mL of ozone 30 µg/mL was injected into the center of the disc. Considering the level of neural root involvement, both groups received 20 mg of triamcinolone injection via transforaminal epidural. Patients were followed up for 12 months regarding score on visual analogue scale and life performance improvement based on Oswestry Disability Index (ODI) and satisfaction level.ResultsAccording to the results, no difference was found between the two groups for ODI variable before intervention, whereas OZG showed better ODI scores in the measured time intervals. In LDG, only a significant difference in terms of ODI score was found between the times of before surgery and the first month.ConclusionIntradiscal ozone injection could be an effective and cost-effective method for treatment of patients with discogenic back pain.

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

Cited by 21 publications

References 25 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

Lumbar Intradiscal Ozone Chemonucleolysis applied together with the epidural steroid treatment

Comparison of percutaneous intradiscal ozone injection with laser disc decompression in discogenic low back pain

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

Cited by 21 publications

References 25 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

Lumbar Intradiscal Ozone Chemonucleolysis applied together with the epidural steroid treatment

Comparison of percutaneous intradiscal ozone injection with laser disc decompression in discogenic low back pain

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