In our experience, intradiscal O2-O3 treatment of selected herniated lumbar disc has revolutionized the percutaneous approach to nerve root disease by making it safer, cheaper, and easier than treatments currently in use. In addition, O2-O3 therapy does not exclude subsequent surgery, should patients fail to respond.
Oxygen-ozone treatment has the advantage of being feasible in virtually all patients with root syndromes. The contraindications of chemo-nucleolysis or nucleoaspiration, which are determined by discography, are a less critical issue with ozone.
On the basis of our results and the assessment of our failures, we recommend careful selection of patients. We avoid broad indications for treatment, thereby ensuring a high success rate.
Accurate diagnosis of the lesion and the spinal level to be treated, along with accurate technical execution under CT, are key factors in ensuring the successful outcome of percutaneous treatment for this common condition.
1. Long MD. Decision making in lumbar disc disease. Clin Neurosurg 39:3651, 1991.
2. Muto M, De Maria G, Izzo R, Fucci G, Aprill I. Nondiscal lumbar radiculopathy: combined diagnostic approach by CT and MR. Riv Neuroradiol 10:165-173, 1997.
3. Bush K, Cowan N, Katz DE, Gishen P. The natural history of sciatica associated with disc pathology. A prospective study with clinical and independent radiologic follow-up. Spine 17(10):1205-1212, 1992.
4. Gangi A, Dietemann JL, Mortazavi R, Pfleger D, Kauff C, Roy C. CT-guided interventional procedures for pain management in the lumbosacral spine. RadioGraphics 18:621-633, 1998.
5. Gallucci M, Splendiani A, Masciocchi C. Spine and spinal cord: neurora-diological functional anatomy. Riv Neuroradiol 11:293-304, 1997.
7. Weinstein SM, Herring SA, Derby R. Contemporary concepts in spine care. Epidural steroid injection. Spine 20(16):1842-1846, 1995.
8. Lowell TD, Errico TJ, Eskenazi MS. Use of epidural steroids after discec-tomy may predispose to infection. Spine 25(4):516-519, 2000.
9. Buchner M, Zeifang F, Brocai DR, Schiltenwolf M. Epidural corticosteroid injection in the conservative management of sciatica. Clin Orthop 375:149156, June 2000.
10. Schmid G, Vetter S, Gottmann D, Strecker EP. CT-guided epidural/peri-neural injection in painful disorders of the lumbar spine: short and extended term results. Cardio vasc Intervent Radiol 22(6):493-498, November/December 1999.
11. Berger O, Dousset V, Delmer O, Pointillart V, Vital JM, Caille JM. Evaluation of the efficacy of foraminal infusions of corticosteroids guided by computed tomography in the treatment of radicular pain by foraminal injection. J Radiol Sep 80(9):917-925, 1999.
12. Muto M, Avella F. Percutaneous treatment of herniated lumbar disc by in-tradiscal oxygen-ozone injection. Intervent Neuroradiol 4:279-286, 1998.
13. Andreula C. Lumbar herniated disk and degenerative changes. Interven-tional spinal treatment with chemiodiscolysis with nucleoptesis with O3 and perigangliar infiltration in 150 cases. Riv Neuroradiol 14(suppl 1):81-88, 2002.
14. Bonetti M., Cotticelli B, et al. Oxygen-ozone therapy vs epidural steroid injection. Riv Neuroradiol 13:203-206, 2000.
15. D'Erme M, Scarchilli A, et al. Ozone therapy in lumbar sciatic pain. Radiol Med 95(1-2):21-24, 1999.
16. Fabris G, Tommasini G, et al. Oxygen-ozone therapy in percutaneous treatment of lumbar HNP. Riv Neuroradiol 12(suppl 4):23, 1999.
17. Leonardi M, Barbara C, et al. Percutaneous treatment of lumbar herniated disk with intradiscal injection of ozone mixture. Riv Neuroradiol 14 (suppl 1): 51-53, 2001.
18. Andreula C, Leonardi M. Chemiodiscolysis and periradicular and peri-ganglionic infiltration with oxygen-ozone in disk herniation. State of art. In: Spine Imaging and Image-Guided Intervention. Oak Brook, IL: American Society of Spine Radiology; 2002.
20. Saal J. The role of inflammation in lumbar spine. Spine 20:1821-1827, 1995.
21. Hang JD, Georgescu HI, et al: Herniated lumbar intervertebral disc spontaneously produces matrix metalloproteinases, nitric oxide, interleukin 6 and prostaglandin E2. Spine 21:271-277, 1996.
22. Oystein PN, Svein IM, Osterud B. The inflammatory properties of contained and noncontained lumbar disc herniation. Spine 22:2484-2488, 1997.
23. Zennaro H, Dousset V, Viaud B, Allard M, Dehais J, Senegas J, Caille JM. Periganglionic foraminal steroid injections performed under CT control. AJNR Am J Neuroradiol 19:349-352, February 1998.
24. Iliakis E. Ozone treatment in low back pain. Orthopaedics 1:29-33, 1995.
25. Bocci V. Ossigeno-ozonoterapia. Comprensione dei meccanismi di azione e possibilitä terapeutiche. Milano: Ambrosiana, 2000.
26. Melzack, R. The McGill Pain Questionnaire: major properties and scoring system. Pain, 1:277-299, 1975.
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Deal With Your Pain, Lead A Wonderful Life An Live Like A 'Normal' Person. Before I really start telling you anything about me or finding out anything about you, I want you to know that I sympathize with you. Not only is it one of the most painful experiences to have backpain. Not only is it the number one excuse for employees not coming into work. But perhaps just as significantly, it is something that I suffered from for years.