Radiation exposure and clinical outcome in patients undergoing percutaneous intradiscal ozone therapy for disc herniation: Fluoroscopic versus conventional CT guidance

Somma, Francesco; D’Agostino, Vincenzo; Negro, Alberto; Piscitelli, Valeria; Tamburrini, Stefania; Sicignano, Carmine; Fasano, Fabrizio; Peluso, Silvio; Villa, Alessandro E. P.; Pace, Gianvito; Sarti, Giuseppe; Tessa, Giuseppe Maria Ernesto La; Pezzullo, Giovanna; Gatta, Gianluca; Caranci, Ferdinando

doi:10.1371/journal.pone.0264767

Cited by 3 publications

(2 citation statements)

References 33 publications

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“…To the best of our knowledge, this is the first study that analyzed the factors associated with radiation exposure during fluoroscopy-guided OCN. In the only previous publication on a similar topic by Somma et al, the authors used fluoroscopy or computed tomography (CT) to guide OCN, and the radiation exposure was reported only as a total value without a detailed analysis based on patient characteristics [36]. Even if Somma et al recently reported the clinical outcome along with radiation exposure after OCN, some consideration is necessary.…”

Section: Discussionmentioning

confidence: 99%

Radiation Exposure during Fluoroscopy-Guided Ozone Chemonucleolysis for Lumbar Disc Herniation

Leoni

Vitali

Micheli

et al. 2022

JCM

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Introduction: Radiation exposure is a frequent drawback of spinal surgery, even if X-ray guidance plays a pivotal role in improving the accuracy and safety of spinal procedures. Consequently, radiation protection is essential to reduce potential negative biological effects. The aim of this study was to evaluate patients’ radiation exposure, the radiation dose emission during fluoroscopy-guided ozone chemonucleolysis (OCN), and the potential role of patient characteristics. Methods: The radiation dose emission reports were retrospectively evaluated in patients who underwent single-level OCN for lumbar disc herniation. A generalized linear model (GLM) with a gamma distribution and log link function was used to assess the association between radiation emission and patients’ characteristics such as age, sex, BMI, level of disc herniation, disc height, and site of disc herniation. Results: Two hundred and forty OCN cases were analyzed. A safe and low level of radiation exposure was registered during OCN. The median fluoroscopy time for OCN was 26.3 (19.4–35.9) seconds, the median radiation emission dose was 19.3 (13.2–27.3) mGy, and he median kerma area product (KAP) was 0.46 (0.33–0.68) mGy ⋅ m2. The resulting KAP values were highly dependent on patient variables. In particular, sex, obesity, and residual disc height <50% significantly increased the measured KAP, while levels of disc herniations other than L5-S1 reduced the KAP values. Conclusions: The radiation exposure during OCN is low and quite similar to a simple discography. However, patient characteristics are significantly related to radiation exposure and should be carefully evaluated before planning OCN.

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Section: Discussionmentioning

confidence: 99%

Radiation Exposure during Fluoroscopy-Guided Ozone Chemonucleolysis for Lumbar Disc Herniation

Leoni

Vitali

Micheli

et al. 2022

JCM

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“…In our department, imaging guidance was performed using fluoroscopy or computed tomography (CT), on the base of operator preference and technique room availability. Previous studies showed how fluoroscopic guidance reduces operative time and radiation exposure in comparison with CT guidance for intradiscal ozone therapy [ 12 , 13 ]. Ozone was collected with a polypropylene 10-mL syringe, and 5 mL of ozone/oxygen mixture at 30 µg/mL concentration rate was injected into the disc.…”

Section: Methodsmentioning

confidence: 99%

COVID-19 and low back pain: previous infections lengthen recovery time after intradiscal ozone therapy in patients with herniated lumbar disc

Somma¹,

Negro²,

D’Agostino³

et al. 2022

Radiol med

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Purpose To assess and compare the clinical effectiveness of percutaneous intradiscal ozone therapy in patients affected by lumbar disc herniation, with and without history of COVID-19 infection. Materials and Methods After the rising of COVID-19 pandemics in Italy, 47 consecutive percutaneous intradiscal ozone therapies were performed on patients with low back pain and/or sciatic pain due to lumbar disc herniation. Among these, 19 had suffered from COVID-19 and successively recovered with no residual symptoms, while the remaining 28 had not previously been affected by COVID-19 and were not convalescent. Oswestry Disability Index (ODI) was administered before the treatment and at 1-month and 3-month follow-up in order to assess the clinical outcome. Results The two groups were similar in terms of patient age ( p -value 0.54), treated levels ( p -value 0.26) and pre-procedure ODI ( p -value 0.33). Technical success was achieved in all cases. In patients previously affected by COVID-19, mean ODI decrease was 11.58 ± 9.51 (35.72%) at 1-month follow-up and 20.63 ± 9.87 (63.63%) at 3-month follow-up. In patients never affected by COVID-19, mean ODI decrease was 20.93 ± 10.53 (58.73%) at 1-month follow-up and 22.07 ± 11.36 (61.92%) at 3-month follow-up. Eventually, clinical success was registered in 84.21% (16/19) of patients with history of COVID-19 infection and in 85.71% (24/28) of patients with no history of COVID-19 infection. No major complication was registered. Conclusions In case of lumbar disc herniation treated with percutaneous intradiscal ozone therapy, patients previously affected by COVID-19 showed a significantly longer recovery time.

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Sex life and low back pain: The impact of intradiscal ozone therapy in patients with herniated lumbar disc

Somma¹,

Negro²,

Tortora

et al. 2023

Interv Neuroradiol

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Study Design Retrospective cohort study. Objectives To assess the improvement of sexual impairment after percutaneous intradiscal ozone therapy in patients complaining of low back pain (LBP) due to lumbar disc herniation. Methods Between January 2018 and June 2021, 157 consecutive imaging-guided percutaneous intradiscal ozone therapies were performed on 122 patients with LBP and/or sciatic pain due to lumbar disc herniation. Oswestry Disability Index (ODI) was administered before the treatment and at 1-month and 3-month follow-ups and the ODI Section 8 (ODI-8/sex life) values were retrospectively reviewed to evaluate the improvement of sexual impairment and disability. Results Mean age of patients was 54.63 ± 12.40. Technical success was achieved in all cases (157/157). Clinical success was registered in 61.97% (88/142) of patients at 1-month follow-up and in 82.69% (116/142) at 3-month follow-up. The mean ODI-8/sex life was 3.73 ± 1.29 before the procedure, 1.71 ± 1.37 at 1-month follow up and 0.44 ± 0.63 at 3-month follow-up. Compared to older patients, subjects under 50 years showed a significantly slower recovery of sexual impairment ( p = 0.003). The treated levels were L3–L4, L4–L5, and L5–S1 in 4, 116, and 37 patients, respectively. Patients with L3–L4 disc herniation showed less sexual disability at presentation, with a significantly faster improvement of sexual life ( p = 0.03). Conclusions Percutaneous intradiscal ozone therapy is highly effective in reducing sexual impairment due to lumbar disc herniation, and the improvement is faster in older patients and in the case of L3–L4 disc involvement.

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Radiation exposure and clinical outcome in patients undergoing percutaneous intradiscal ozone therapy for disc herniation: Fluoroscopic versus conventional CT guidance

Cited by 3 publications

References 33 publications

Radiation Exposure during Fluoroscopy-Guided Ozone Chemonucleolysis for Lumbar Disc Herniation

Radiation Exposure during Fluoroscopy-Guided Ozone Chemonucleolysis for Lumbar Disc Herniation

COVID-19 and low back pain: previous infections lengthen recovery time after intradiscal ozone therapy in patients with herniated lumbar disc

Sex life and low back pain: The impact of intradiscal ozone therapy in patients with herniated lumbar disc

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