Radiofrecuencia pulsada (Rf) y ozono intradiscal en el alivio del dolor discogénico: experiencia en 51 casos

Abstract

Objective: About 40 % cases of lumbosacral pain has source in intervertebral disc. Degeneration and nucleus pulposus dehydration can produce tears in the annulus that stimulates growth irrigation and nocioceptors formation at this level and this could be the cause of discogenic pain. Intradiscal radiofrecuency (Rf) has 2B± evidence level for the discogenic pain relief. Our goal was to test if addition of intradiscal ozone to intradiscal Rf treatment could improve outcomes. Material and methods: Observational prospective study in which fifty-one patients with discogenic pain were treated. Inclusion criteria: a) Pain's evolution higher than eight months; b) VAS higher than seven; c) non radicular pain characteristics; d) lumbosacral pain with uni-or bilateral buttock irradiation; e) without response to pharmacologic and interventional treatment; f) discal degeneration o presence of a high-intensity zone in RM; g) discography with 30 % ozone: Not evidence of fuga to epidural space with addition of 3-8 ml ozone in nucleus pulposus. Patients were randomized in three groups: A-Just intradiscal ozone (3-8 ml). B-Intradiscal ozone and next RfP (2 Hz, 10 miliseg, 60 V) for 15 minutes (Neurotherm). C-Intradiscal-Pulsed Rf (with same parameters). Pulsed Rf parameters were recorded during the procedure: impedance, temperature, voltage and mA. Patients were evaluated at three and twelve months of the technique. Parameters evaluated were: EVA, improve percentage (no effect/EVA > 2/EVA > 50 %). Chosen statistical program was SPSS 16.0, t-student for average comparison, p-simple binomial for percentage comparison (p < 0.05). Results: More EVA reduction at three and twelve months on the B group (8.1 ± 1.1/3.7 ± 1.9/4 ± 2.2) (p < 0.01). All patients from B group significantly improve at three months and 88.2 % of the patients' improvement continuous for twelve months (p < 0.05). Conclusions: The association of intradiscal ozone with pulsed Rf can improve the results of the ozone's application in discogenic pain.

Effectiveness of ozone therapy compared to other therapies for low back pain: a systematic review with meta-analysis of randomized clinical trials

“…Thus, we identified 15 articles for full-text reading. Of these, only six 15 , 16 , 17 , 18 , 19 , 20 remained for the final analysis. Of the nine excluded articles, five 21 , 22 , 23 , 24 , 25 were not retrieved in full even after attempting to contact their authors; one 26 was not a randomized clinical trial; one 27 was a letter to the editor; one 28 was an editorial; and one 29 centered on complications during surgical procedure.…”

“… 16 And five were considered at an uncertain risk of bias, as they did not report enough information to define confidentiality. 17 , 18 , 19 , 20 Blinding of participants and personnel : Only one study was considered at low risk of bias, as it reports that participants were informed of the possibility of being allocated to the placebo group without their knowledge. 16 One was considered at high risk of bias, as it implies that patients knew which group they belonged to.…”

“… 16 Selective reporting : Four studies were considered at low risk of bias, as they presented in the results all the proposed variables. 16 , 17 , 19 , 20 While two were considered at high risk of bias: one for presenting data in the results that were not proposed in the variables, but only addressed as inclusion criteria 18 : and one for not presenting data in the results regarding some variables proposed. 15 Other bias : Only one study was considered at low risk of bias and the only one to satisfactorily describe the statistical analysis, including sample size calculation.…”

“…15 And four studies were considered at an uncertain risk of bias, as the authors did not make clear the blindness of both participants and personnel. 17 , 18 , 19 , 20 …”

“…Five studies used the pain relief variable, three of them as complete pain relief 15 , 16 , 19 and two used the visual analogue pain scale. 17 , 18 Meta-analysis was only possible at three months, which was performed by two studies. 15 , 16 There was no statistically significant difference between groups using ozone and other therapies (RR = 1.98; 95% CI: 0.46–8.42; p = 0.36; 366 participants); and at six months using it, three studies 15 , 16 , 19 reported that ozone therapy was statistically superior regarding benefit compared to other therapies (RR = 2.2; 95% CI: 1.87–2.60; p < 0.00001; 717 participants).…”