Ultrasound Guidance in Paravertebral Injections of Oxygen-Ozone: Treatment of Low Back Pain

Abstract

Background: Paravertebral injection of ozone is an established clinical practice for the treatment of Low Back Pain (LBP). The role of Ultrasound Guidance (USG) in mini invasive procedures has become important in many clinical practice thanks to the greater precision this technique can add. As matter of fact, a large volume of ozone in a single administration may have some adverse or side effects. In this study we wanted to verify if the use of USG in Oxygen/ Ozone (O2/O3) infiltrations could allow the administration of a smaller volume of gas mixture, increasing the safety and the comfort of the procedure itself, obtaining however similar or better results in pain decrease.\ud Methods: We compared two groups of 25 patients affected by LBP, undergoing 10 infiltrations of O2/O3, by using USG (group U) or only anatomical landmarks (group AL). Pain intensity, by calculating Visual Analogical Scale (VAS) difference before and after the treatment, and the discomfort were evaluated in both groups. \ud Results: The mean of the VAS before the treatment was 6.44 in group U and 6.48 in group AL. The mean of the VAS after the treatment was 2.22 in group U and 3.04 in group AL. The mean of discomfort rate was 2.84 in group U and 5.44 in group AL. The number of patients with unbearable discomfort was 0 in group U and 7 in group AL. \ud Conclusions: As many other treatment, also paravertebral injections of O2/O3 benefits of the advantages of the US device which makes this treatment safer and more accurate

Review of intervertebral hernia disease treatment methodologies: Key emphasis on the oxygen-ozone therapy as a method with multifactorial influence

“…The study demonstrated a significant improvement of treatment outcomes by using the ultrasound-guided deep injection with a smaller volume of oxygen-ozone solution into the area of the affected IVD. 27 The data from numerous published studies have confirmed the effectiveness of the ozone therapy for lower back treatment with or without sciatica. 3,25,47,48 Other studies compared the efficacy of analgesia and the duration of remission in patients with different courses of treatment: the use of ozone therapy-only vs. pharmacotherapy.…”

“…Another reported side effect is a burning sensation at the area of innervation of spinal root related to the injection technique mistakes or high concentration of the oxygen-ozone mixture at the site of infiltration. 27,29 Morselli et al (2015) set the goal to reduce the likelihood of adverse effects associated with ozone therapy. They studied outcomes of the paravertebral administration of a smaller volume of the ozonated mixture (10 mL) and the possibility to use ultrasound-guided injections.…”

“…3,25,47,48 Other studies compared the efficacy of analgesia and the duration of remission in patients with different courses of treatment: the use of ozone therapy-only vs. pharmacotherapy. 27,35 Thus, the first group underwent a local intra-foraminal or a peridural administration of steroids, and in the second group -a local administration of the oxygen-ozone mixture. 45 Vivekananda et al (conducted a clinical study to determine the impact of the chronic spinal pathology complicated by IVH.…”

US/CT fusion imaging and virtual navigation to guide lumbar intradiscal oxygen-ozone therapy: a pilot study

“…Although controversial results have been reported, recent data support the use of O 2 /O 3 injections for treating LDH, with substantial and significant clinical improvement after treatment, as reported by a recent meta-analysis [ 3 ]. Injections can be performed under imaging guidance (CT, fluoroscopy or, less frequently, ultrasound), which ensures needle tip positioning exactly at the specific target [ 4 – 8 ]. Alternatively, injections may be performed without imaging guidance in the muscular paravertebral tissues at the level of pathologic disc.…”

“…In this setting, a recent meta-analysis has shown that image-guided O 2 /O 3 mixture injection had better performance for LBP when compared to non-image-guided procedures, with better effectiveness and lower age-related variability in outcomes [ 4 ]. Ultrasound (US) guidance has been rarely used for O 2 /O 3 injections in the spine, for procedures involving foraminal [ 5 ] and paravertebral muscles [ 8 ] injections. No previous studies focused on the application of US to guide O 2 /O 3 injections in the lumbar discs, due to deep location of the disc that can be hardly recognized on US.…”