Clinical Experience

Between 1997 and 2002, 1800 patients between the ages of 18 and 89 underwent percutaneous chemodiscolysis with periradicular and pari-ganglionic injection of the oxygen-ozone mixture. The following selection criteria were adopted:

1. Clinical: low back and/or nerve root pain that is resistant to medical treatment, physiotherapy, and homeopathic therapies (manipulation, acupuncture, etc.) for a period of not less than 2 months

2. Psychological: a firm resolve on the part of the patient to recover, with a commitment to cooperate and undergo subsequent physiotherapy with postural and motor rehabilitation

3. Neurological: paresthesia or hypoesthesia over the dermatome involved, mild muscle weakness, and signs of root-ganglion irritation

4. Neuroradiological (CT and/or MR):

a. Evidence of small or medium-sized herniated discs correlating with the patient's symptoms, with or without degenerative disc disease complicated by intervertebral disc changes (protrusion, herniation)

b. Residue of surgical (micro) discectomy with herniation recurrence and/or hypertrophic fibrous scarring

Figure 19.1. (A) Intradiscal positioning of the 20-gauge Chiba needle under CT guidance in a patient with median and left paramedian herniated nucleus pulposus. (B) CT axial image after intradiscal injection of 4 mL of oxygen-ozone mixture.

There were two exclusion criteria:

1. CT/MR evidence of a herniated disc fragment with symptoms of motor and/or sphincter disturbance

2. CT/MR evidence of disc herniation corresponding to clinically severe motor deficit and/or sphincter disturbance a b

Sphincter Disturbances

Figure 19.1. Continued. (C) Multiplanar reconstruction with evidence of gas inside the disc.

Figure 19.1. Continued. (C) Multiplanar reconstruction with evidence of gas inside the disc.

The indications for O2-O3 treatment were extended to FBSS patients when it was understood that the ozone mechanisms of action could be exploited to treat the chronic inflammation and venous stasis present in FBSS.

Because of the need for meticulous positioning of the needle within the nucleus pulposus, CT guidance was adopted instead of the well-tested radiological monitoring by isocentric fluoroscopy. In addition, CT avoids the administration of intradiscal contrast material, which even in low doses reduces the discal absorption of ozone and the available space. It may also hinder visualization during the intraforaminal injection of the O2-O3 mixture.

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