Skip to main content

Advertisement

SpringerLink
Log in

Low back pain and sciatica: treatment with intradiscal-intraforaminal O2-O3 injection. Our experience

“Low back pain” e sciatalgia: trattamento con iniezione intradiscale-intraforaminale di O2-O3. La nostra esperienza

  • Neuroradiology/Neuroradiologia
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

This paper describes discolysis by intradiscal, periganglionic and periradicular oxygen-ozone (O2-O3) injection, a minimally invasive percutaneous technique for the treatment of lumbar disk herniation.

Materials and methods

From June 2000 to December 2006, we performed O2-O3 chemonucleolysis procedures in 2,900 patients affected by lumbar disk herniation. Patients were selected on the basis of clinical, psychological, neurological and neuroradiological criteria. Exclusion criteria were extruded hernia and/or free disc fragments, hyperalgesic-paralysing sciatica and progressive neurological impairment of the affected limb. All percutaneous treatments were performed under computed tomography (CT) guidance. All patients were evaluated after 1 month, and those showing only partial success were scheduled for a second treatment session.

Results

Results were evaluated with the modified MacNab classification, the visual analogue scale and the Oswestry Disability Index at 6 and 12 months. Success rates were 75%–80% for soft disc herniation, 70% for multiple-disc herniations and 55% for failed back surgery syndrome. None of the patients suffered early or late neurological or infectious complications.

Conclusions

According to our data, minimally invasive percutaneous treatment by intradiscal, periradicular or periganglionic O2-O3 infiltration is a valuable and competitive technique that provides excellent results at low cost and without complications.

Riassunto

Obiettivo

Illustrare la tecnica mini-invasiva percutanea di infiltrazione di ossigeno-ozono (chemiodiscolisi con miscela di O2-O3) intradiscale, perigangliare e periradicolare per il trattamento delle ernie del disco lombari.

Materiali e metodi

Dal giugno 2000 al dicembre 2006 sono state eseguite 2900 procedure di infiltrazione di O2-O3 in pazienti affetti da ernia discale lombare. Tutti i pazienti sono stati selezionati secondo criteri clinici, psicologici, neurologici e neuroradiologici. I criteri di esclusione sono stati: ernia discale espulsa e/o frammento erniario libero, grave deficit motorio dell’arto e/o disturbi sfinterici, sciatalgia iperalgica, deficit neurologico progressivo dell’arto interessato. La tecnica percutanea è stata sempre eseguita sotto guida TC. Tutti i pazienti sono stati valutati a distanza di un mese dal primo trattamento e sottoposti a un secondo trattamento percutaneo in caso di successo parziale.

Risultati

I risultati sono stati valutati secondo la scala di “Mac Nab modificata”, secondo la “Visual Analogyc Scale” (VAS) e “Oswestry Disability Scale” (ODS) a sei e dodici mesi con un successo variabile tra il 75% e l’80% per le ernie discali molli; 70% per le ernie discali multiple e 55% per la sindrome da fallimento chirurgico (FBSS). Non è stata riportata nessuna complicanza neurologica o infettiva nel breve o lungo follow-up.

Conclusioni

Secondo la nostra casistica, il trattamento percutaneo mini-invasivo con infiltrazione di O2-O3 intradiscale e periradicolare risulta essere un’alternativa valida e competitiva rispetto alle altre tecniche percutanee garantendo un ottimo risultato terapeutico in termini percentuali, a basso costo, facilmente ripetibile e in assenza di complicanze.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References/Bibliografia

  1. Long MD (1991) Decision making in lumbar disc disease. Clinical Neurosurg 39:36–51

    Google Scholar 

  2. Muto M, De Maria G, Izzo R et al (1997) Nondiscal lumbar radiculopathy: combined approach by CT and MR. Riv Neuroradiol, 10:165–173

    Google Scholar 

  3. Bush K, Cowan N, Katz DE et al (1992) The natural history of sciatica associated with disc pathology. A prospective study with clinical and independent radiologic followup Spine, 17 (10):1205–1

    Article  PubMed  CAS  Google Scholar 

  4. Gangi A, Dietemann JL, Mortazavi R et al (1998) CT-guided interventional procedures for pain management in the lumbosacral spine. Radiographics, 18(3):621–33

    PubMed  CAS  Google Scholar 

  5. Gallucci M, Splendiani A, Ma sciocchi C (1997) Spine and spinal cord: neuroradiological funcional anatomy Riv Neuroradiol, 11:293–304

    Google Scholar 

  6. Von Tulder MW, Koes BW, Bouter LM (1997) Conservative treatment of acute and chronic non-specific low back pain.Spine, 22:2128–2156

    Article  PubMed  Google Scholar 

  7. Saal J (1995) The role of inflammation in lumbar spine Spine, 20:1821–1827

    Article  PubMed  CAS  Google Scholar 

  8. Onik GM (2000) Percutaneous diskectomy in the treatment of herniated lumbar disks. Neuroimaging Clin N Am.10(3):597–607

    PubMed  CAS  Google Scholar 

  9. Muto M (2004) Alterazioni indotte da infiltrazioni intradiscali e intramuscolari di ossigeno-ozono: studio anatomo-patologico.Risultati preliminari. Riv. Italiana di Ossigeno-Ozonoterapia 3:7–13

    Google Scholar 

  10. Smith L (1964) Enzyme dissolution of the nucleus pulposus in humans Jama 11; 187:137–40

    Google Scholar 

  11. Nordby EJ, Wright PH, Schofield SR (1993) Safety of chemonucleolysis. Adverse effects reported in the United States 1982–1991 Review. Clin Orthop Relat Res. 293:122–34

    PubMed  Google Scholar 

  12. Gibby W (2002) Automated percutaneous discectomy. In: Williams AL, M FR, Editors. Handbook of diagnostic and theurapeutic spine procedures. St. Liouis: Mosby: 203–225

    Google Scholar 

  13. Choy DS (2004) Percutaneous laser disc decompression: a 17-year experience. Photomed Laser Surg. Oct; 22(5):407–10. Review

    Article  Google Scholar 

  14. Gibson JNA, Grant IC, Waddell G (2003) Surgery for lumbar disc prolapse (Cochrane Review). In The Cochrane Library. Oxford: Update Software.: Issue 2

    Google Scholar 

  15. Saal JA, Saal JS (2000) Intradiscal electrothermal treatment for chronic discogenic low back pain: a prospective outcome study with minimum 1-year follow-up. Spine.25(20):2622–7

    Article  PubMed  CAS  Google Scholar 

  16. Eckel TS (2002) Intradiscal electrothermal therapy. In Williams AL, Murtagh FR, Editors.Handbook of diagnostic and theurapeutic spine procedures. St. Louis: Mosby.:229–244

    Google Scholar 

  17. Vijay S, M.D., et al (2002) Percutaneous Disc Decompression Using Coblation (NucleoplastyTM) in the Treatment of Chronic Discogenic Pain. Pain Physician, 5(3):250–259

    Google Scholar 

  18. Sharps L (2002) Percutaneous Disc Decompression Using Nucleoplasty Pain Physician., 5(2):121–126

    PubMed  Google Scholar 

  19. Kenneth M, Robert E (2004) Percutaneous lumbar discectomy: clinical response in an initial cohort of fifty consecutive patients with chronic radicular pain. Pain Pract, 4:19–27

    Article  Google Scholar 

  20. Amoretti N, Huchot F, Flory P et al (2005) Percutaneous nucleotomy: preliminary communication on a decompression probe (Dekompressor) in percutaneous discectomy. Ten case reports. Clin Imaging, 29:98–101

    Article  PubMed  CAS  Google Scholar 

  21. Andreula C, Muto M, Leonardi M (2004) Interventional spinal procedures. Eur J Radiol., 50(2):112–9. Review

    Article  PubMed  Google Scholar 

  22. Muto M, Andreula C, Leonardi M (2004) Treatment of herniated lumbar disc by intradiscal and intraforaminal oxygen-ozone (O2-O3) injection J Neuroradiol., 31(3),183–9

    Article  PubMed  CAS  Google Scholar 

  23. Andreula CF, Simonetti L, De Santis F et al (2003) Minimally invasive oxygen-ozone therapy for lumbar disk herniation. AJNR 24:996–1000

    PubMed  Google Scholar 

  24. Muto M, Avella F (1998) Percutaneous treatment of herniated lumbar disk by intradiscal oxygen-ozone injection. Intervent Neuroradiol 4:279–286

    Google Scholar 

  25. Tian JL et al (2007) Changes of CSF and spinal pathomorphology after hightconcentration ozone injection into the subarachnoid space:an experimental study in pigs. AJNR 28:1051–54

    PubMed  CAS  Google Scholar 

  26. Iliakis E (1995) Ozone treatment in low bak pain. Orthopaedics 1:29–33

    Google Scholar 

  27. Fabris G, Tommasini G, et al (1999) Oxygen-ozone therapy in percutaneous treatment of lumbar HNP. Riv Neuroradiol, 12 [suppl 4]:23

    Google Scholar 

  28. D’Erme M, Scarchilli A et al (1999) Ozone therapy in lumbar sciatic pain. Radiol Med, 95 (1–2):21–24

    Google Scholar 

  29. Bocci V. Ossigeno-ozonoterapia. Comprensione dei meccanismi di azione e possibilità terapeutiche. Milano: Ambrosiana 2000

    Google Scholar 

  30. Bonetti M, Cotticelli B et al (2000) Oxygen-ozone therapy vs epidural steroid injection. Riv Neuroradiol.13:203–206

    Google Scholar 

  31. Leonardi M, Barbara C et al (2001) Percutaneous treatment of lumbar herniated disk with intradiscal injection of ozone misture. Riv Neuroradiol, 14 [suppl 1]:51–53

    Google Scholar 

  32. Andreula C (2002) Lumbar herniated disk and degenerative changes. Interventional spinal treatment with chemiodiscolysis with nucleoptesis with 03 and perigangliar infiltration in 150 cases. Riv Neuroradiol, 14 (suppl 1):81–88

    Google Scholar 

  33. Andreula C, Leonardi M (2002) Chemiodiscolysis and periradicular and periganglionic infiltration with oxygenozone in disk herniation. State of art. In Spine Imaging and Image-Guided. Intervention. Oak Brook, IL American Society of Spine Radiology

    Google Scholar 

  34. Wilco CP, van Houwelingen H et al (2007) Surgery versus Prolonged Conservative Treatment for Sciatica, for the Leiden-The Hague Spine Intervention Prognostic Study Group* The new england journal of medicine vol 356 n. 22 pp. 2245–56

    Article  Google Scholar 

  35. Andreula C (2005) Interventional Spinal procedures Riv. Neurorad. 18/Sup.2:71–74

    Google Scholar 

  36. Gallucci M, Limbucci N, Masciocchi C et al (2007) Sciatica: Treatment with Intradiscal and Intraforaminal Injections of Steroid and Oxygen-Ozone versus Steroid Only Radiology: Vol. 242(3):907–17

    Article  PubMed  Google Scholar 

  37. Bonetti M, Leonardi M et al (2005) Intraforaminal O2-O3 versus Periradicular Steroidal Infiltrations in Lower Back Pain:Randomized Controlled AJNR 26:996–1000

    PubMed  Google Scholar 

  38. Muto M et al (2003) L’insuccesso terapeutico nel trattamento con O2-O3 intradiscaleintraforaminale nei conflitti disco-radicolari. Riv. Neuroradiologia 16 suppl. 1:82–84

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. U.O.C. Neuroradiologia A.O.R.N.A. Cardarelli Napoli, Napoli, Italy

    M. Muto, G. Ambrosanio, G. Guarnieri & E. Capobianco

  2. Cattedra di Radiologia Seconda Università degli Studi di Napoli, Napoli, Italy

    G. Piccolo, G. Annunziata & A. Rotondo

Authors
  1. M. Muto
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. Ambrosanio
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G. Guarnieri
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E. Capobianco
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. Piccolo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. G. Annunziata
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A. Rotondo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Muto.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Muto, M., Ambrosanio, G., Guarnieri, G. et al. Low back pain and sciatica: treatment with intradiscal-intraforaminal O2-O3 injection. Our experience. Radiol med 113, 695–706 (2008). https://doi.org/10.1007/s11547-008-0302-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11547-008-0302-5

Keywords

Parole chiave

Search

Navigation