Is Intradiscal Ozone Injection Effective in Ameliorating Symptoms of Lumbosacral Discopathy?
-
Mohammadreza Golbakhsh
,
Maryam Mirshahi
,
Mohammadreza Bozorgmanesh
,
Mazaher Ebrahimian
,
Seyyed Hossein Shafiei
,
Babak Siavashi
,
Farhad Mahdavi
,
Yousef Fallah
Abstract
Introduction: Oxygen ozone gas mixture as a newly prescribed substance became popular among clinicians to relieve low back pain in discogenic patients as an alternative method rather than surgery. It is believed multiple metabolic pathways intervein within its site of action with nucleus pulposus. We developed this study to uncover whether this combination could be helpful in the middle Eastern population or not.
Methods: In the present randomized clinical trial study, we included 40 patients with L1 to S1 disc herniation based on MRI verification within years 2018-2019 who did not respond to 6 weeks of physiotherapy. All patients were followed with a mean time of 12 weeks after injection, and pain VAS score and SF-36 score were performed for all patients. The severity of disc herniations was evaluated by a spine surgeon within the Michigan State University (MSU) classification frame.
Results: Nine out of 40 patients were unexpectedly excluded during our study due to their absence for follow-up. The present study showed that the mean distribution of the patient’s sex, age, BMI, smoking was not contrasting between the two groups (p>0.05). The current study represented two groups were identical regarding Lumbosacral segment involvement during 12 weeks of our survey (p>0.05). SF-36 score graphical inclination was equivalent in both intervention and control groups. The mean VAS score was primarily decreased after two weeks in the intervention group in comparison with the control group, but it failed to thrive in the following weeks and was raised afterward. On the other hand mean VAS score for the control group (6.1; 95% CI: 5.4-6.8) proceeded with a steady slope notably lower than the intervention group (7.5; 95% CI: 6.9-8.2; P<0.001).
Conclusion: In conclusion, referring to statistical outcomes inferred from our study, we understood oxygen-ozone mixture injection is not beneficial in patients with low back pain.
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2. Nociti V, Picarelli C, Losavio FA, Reale G, Giuliano G, Della Marca G, et al. Posterior reversible encephalopathy syndrome after intramuscular oxygen-ozone therapy. Can J Neurol Sci. 2020;47(3):416-8. doi: 10.1017/cjn.2020.35. [PubMed:32077386].
3. de Sire A, Stagno D, Minetto MA, Cisari C, Baricich A, Invernizzi M. Long-term effects of intra-articular oxygen-ozone therapy versus hyaluronic acid in older people affected by knee osteoarthritis: A randomized single-blind extension study. J Back Musculoskelet Rehabil. 2020;33(3):347-54. doi: 10.3233/BMR-181294. [PubMed:32144974].
4. Haseeb AESA, Abd El Hares AEH, Abd El Moez KM, Mustafa AI, Ahmed OEA. Comparative study between treatment of lumbar disc herniation with intra discal ozone and transforaminal steroid injection versus steroid injection only. Egypt J Hosp Med. 2019;74(4):705-20. doi: 10.21608/EJHM.2019.24068.
5. Hosseini B, Taheri M, Sheibani K. Comparing the results of intradiscal ozone injection to treat different types of intervertebral disc herniation based on MSU classification. Interv Neuroradiol. 2019;25(1):111-6. doi: 10.1177/1591019918800458. [PubMed:30227808]. [PubMed Central: PMC6378534].
6. Bhatia A, Munk P, Lee D, Elias G, Murphy K. percutaneous ozone treatment for herniated lumbar discs: 1-year follow-up of a multicenter pilot study of a handheld disposable ozone-generating device. J Vasc Interv Radiol. 2019;30(5):752-60. doi: 10.1016/j.jvir.2018.09.037. [PubMed:30922796].
7. Dall'Olio M, Princiotta C, Cirillo L, Budai C, de Santis F, Bartolini S, et al. Oxygen-ozone therapy for herniated lumbar disc in patients with subacute partial motor weakness due to nerve root compression. Interv Neuroradiol. 2014;20(5):547-54. doi: 10.15274/INR-2014-10078. [PubMed:25363257]. [PubMed Central:PMC4243224].
8. Steppan J, Meaders T, Muto M, Murphy KJ. A metaanalysis of the effectiveness and safety of ozone treatments for herniated lumbar discs. J Vasc Interv Radiol. 2010;21(4):534-48. doi: 10.1016/j.jvir.2009.12.393. [PubMed:20188591].
9. Magalhaes FN, Dotta L, Sasse A, Teixera MJ, Fonoff ET. Ozone therapy as a treatment for low back pain secondary to herniated disc: A systematic review and meta-analysis of randomized controlled trials. Pain Physician. 2012;15(2): E115-E129. [PubMed:22430658].
10. Muto M, Giurazza F, Silva RP, Guarnieri G. Rational approach, technique and selection criteria treating lumbar disk herniations by oxygen-ozone therapy. Interv Neuroradiol. 2016;22(6):736-40. doi: 10.1177/1591019916659266. [PubMed:27485047]. [PubMed Central:PMC5564357].
11. Iliakis E, Valadakis V, Vynios DH, Tsiganos CP, Agapitos E. Rationalization of the activity of medical ozone on intervertebral disc a histological and biochemical study. Rivista di Neuroradiologia. 2001;14(1_suppl):23-30. doi: 10.1177/19714009010140S105.
12. Murphy K, Elias G, Steppan J, Boxley C, Balagurunathan K, Victor X, et al. Percutaneous treatment of herniated lumbar discs with ozone: Investigation of the mechanisms of action. J Vasc Interv Radiol. 2016;27(8):1242-50. doi: 10.1016/j.jvir.2016.04.012. [PubMed:27363296].
13. Bocci V, Luzzi E, Corradeschi F, Paulesu L, Di Stefano A. Studies on the biological effects of ozone: 3. An attempt to define conditions for optimal induction of cytokines. Lymphokine Cytokine Res. 1993;12(2):121-6. [PubMed:8324077].
14. Rahimi-Movaghar V, Eslami V. The major efficient mechanisms of ozone therapy are obtained in intradiscal procedures. Pain Physician. 2012;15(6):E1007-8. [PubMed:23159972].
15. Zhang Y, Ma Y, Jiang J, Ding T, Wang J. Treatment of the lumbar disc herniation with intradiscal and intraforaminal injection of oxygen-ozone. J Back Musculoskelet Rehabil. 2013;26(3): 317-22. doi: 10.3233/BMR-130386. [PubMed:23893147].
16. Ware JE. SF-36 health survey update. Spine (Phila Pa 1976). 2000;25(24):3130-9. doi: 10.1097/00007632-200012150-00008. [PubMed:11124729].
17. Bocci V, Borrelli E, Zanardi I, Travagli V. The usefulness of ozone treatment in spinal pain. Drug Des Devel Ther. 2015;9:2677-85. doi: 10.2147/DDDT.S74518. [PubMed:26028964]. [PubMed Central:PMC4440430].
18. Mysliwiec LW, Cholewicki J, Winkelpleck MD, Eis GP. MSU classification for herniated lumbar discs on MRI: Toward developing objective criteria for surgical selection. Eur Spine J. 2010;19(7):1087-93. doi: 10.1007/s00586-009-1274-4. [PubMed:20084410]. [PubMed Central:PMC2900017].
19. Gallucci M, Limbucci N, Zugaro L, Barile A, Stavroulis E, Ricci A, et al. Sciatica: treatment with intradiscal and intraforaminal injections of steroid and oxygen-ozone versus steroid only. Radiology. 2007;242(3):907-13. doi: 10.1148/radiol.2423051934. [PubMed:17209164].
20. Muto M, Ambrosanio G, Guarnieri G, Capobianco E, Piccolo G, Annunziata G, et al. Low back pain and sciatica: Treatment with intradiscal-intraforaminal O(2)-O (3) injection. Our experience. Radiol Med. 2008;113(5):695-706. doi: 10.1007/s11547-008-0302-5. [PubMed:18594765].
21. de Andrade RR, de Oliveira-Neto OB, Barbosa LT, Santos IO, de Sousa-Rodrigues CF, Barbosa FT. Effectiveness of ozone therapy compared to other therapies for low back pain: a systematic review with meta-analysis of randomized clinical trials. Braz J Anesthesiol. 2019;69(5):493-501. [In Portuguese]. doi: 10.1016/j.bjan.2019.06.007. [PubMed:31521383]. [PubMed Central:PMC9391853].
22. He R, Huang Q, Yan X, Liu Y, Yang J, Chen X. A case of paradoxical embolism causing anterior spinal cord syndrome and acute myocardial infarction following the intradiscal oxygen-ozone therapy. Front Neurol. 2019;10:137. doi: 10.3389/fneur.2019.00137. [PubMed:30853936]. [PubMed Central:PMC6395432].
23. Chirchiglia D, Chirchiglia P, Stroscio C, Volpentesta G, Lavano A. Suspected pulmonary embolism after oxygen-ozone therapy for low back pain. J Neurol Surg A Cent Eur Neurosurg. 2019;80(6):503-6. doi: 10.1055/s-0039-1685197. [PubMed:31430795].
24. Andreini I, Arrigucci U, Monti L, Bellini M, Battisti C, Federico A. A case of pneumocephalus as complication of ozone therapy: Diagnosis and treatment. Neurol Sci. 2020;41(2):481-3. doi: 10.1007/s10072-019-04062-4. [PubMed:31478149].
25. Vanni D, Galzio R, Kazakova A, Pantalone A, Sparvieri A, Salini V, et al. Intraforaminal ozone therapy and particular side effects: Preliminary results and early warning. Acta Neurochir (Wien). 2016;158(3):491-6. doi: 10.1007/s00701-015-2545-y. [PubMed:26293228].
26. Vanni D, Pappaccogli R, Pantalone A, D'Adamo D, Salini V (2016) Intraforaminal ozone therapy and particular side effects: All that glitters aren't gold. J Pain Relief. 2016;5:254. doi: 10.4172/2167-0846.1000254.
27. Hao K, Liu H, Yang Y, Zeng Q, He X. Analysis of the efficacy of ozone therapy on different types of lumbar disc herniation: A new guidance is coming? [abstract]. J Ozone Ther. 2019;3(4):26. doi: 10.7203/jo3t.3.4.2019.15506.
28. Mirzashahi B, Farzan M. Is late neurologic decompression effective in traumatic spinal cord injury? Report of two cases and review of the literature. J Orthop Spine Trauma. 2016;2(2): e5629. doi: 10.17795/jost-5629.
29. Moazen Jamshidi MM, Moharrami A, Mirghaderi SP, Sharifpour S, Mafi AR, Mortazavi SJ. The role of spinopelvic parameters in total hip arthroplasty: A current concept review. J Orthop Spine Trauma. 2022;8(2):40-3. doi: 10.18502/jost.v8i2.9308.
2. Nociti V, Picarelli C, Losavio FA, Reale G, Giuliano G, Della Marca G, et al. Posterior reversible encephalopathy syndrome after intramuscular oxygen-ozone therapy. Can J Neurol Sci. 2020;47(3):416-8. doi: 10.1017/cjn.2020.35. [PubMed:32077386].
3. de Sire A, Stagno D, Minetto MA, Cisari C, Baricich A, Invernizzi M. Long-term effects of intra-articular oxygen-ozone therapy versus hyaluronic acid in older people affected by knee osteoarthritis: A randomized single-blind extension study. J Back Musculoskelet Rehabil. 2020;33(3):347-54. doi: 10.3233/BMR-181294. [PubMed:32144974].
4. Haseeb AESA, Abd El Hares AEH, Abd El Moez KM, Mustafa AI, Ahmed OEA. Comparative study between treatment of lumbar disc herniation with intra discal ozone and transforaminal steroid injection versus steroid injection only. Egypt J Hosp Med. 2019;74(4):705-20. doi: 10.21608/EJHM.2019.24068.
5. Hosseini B, Taheri M, Sheibani K. Comparing the results of intradiscal ozone injection to treat different types of intervertebral disc herniation based on MSU classification. Interv Neuroradiol. 2019;25(1):111-6. doi: 10.1177/1591019918800458. [PubMed:30227808]. [PubMed Central: PMC6378534].
6. Bhatia A, Munk P, Lee D, Elias G, Murphy K. percutaneous ozone treatment for herniated lumbar discs: 1-year follow-up of a multicenter pilot study of a handheld disposable ozone-generating device. J Vasc Interv Radiol. 2019;30(5):752-60. doi: 10.1016/j.jvir.2018.09.037. [PubMed:30922796].
7. Dall'Olio M, Princiotta C, Cirillo L, Budai C, de Santis F, Bartolini S, et al. Oxygen-ozone therapy for herniated lumbar disc in patients with subacute partial motor weakness due to nerve root compression. Interv Neuroradiol. 2014;20(5):547-54. doi: 10.15274/INR-2014-10078. [PubMed:25363257]. [PubMed Central:PMC4243224].
8. Steppan J, Meaders T, Muto M, Murphy KJ. A metaanalysis of the effectiveness and safety of ozone treatments for herniated lumbar discs. J Vasc Interv Radiol. 2010;21(4):534-48. doi: 10.1016/j.jvir.2009.12.393. [PubMed:20188591].
9. Magalhaes FN, Dotta L, Sasse A, Teixera MJ, Fonoff ET. Ozone therapy as a treatment for low back pain secondary to herniated disc: A systematic review and meta-analysis of randomized controlled trials. Pain Physician. 2012;15(2): E115-E129. [PubMed:22430658].
10. Muto M, Giurazza F, Silva RP, Guarnieri G. Rational approach, technique and selection criteria treating lumbar disk herniations by oxygen-ozone therapy. Interv Neuroradiol. 2016;22(6):736-40. doi: 10.1177/1591019916659266. [PubMed:27485047]. [PubMed Central:PMC5564357].
11. Iliakis E, Valadakis V, Vynios DH, Tsiganos CP, Agapitos E. Rationalization of the activity of medical ozone on intervertebral disc a histological and biochemical study. Rivista di Neuroradiologia. 2001;14(1_suppl):23-30. doi: 10.1177/19714009010140S105.
12. Murphy K, Elias G, Steppan J, Boxley C, Balagurunathan K, Victor X, et al. Percutaneous treatment of herniated lumbar discs with ozone: Investigation of the mechanisms of action. J Vasc Interv Radiol. 2016;27(8):1242-50. doi: 10.1016/j.jvir.2016.04.012. [PubMed:27363296].
13. Bocci V, Luzzi E, Corradeschi F, Paulesu L, Di Stefano A. Studies on the biological effects of ozone: 3. An attempt to define conditions for optimal induction of cytokines. Lymphokine Cytokine Res. 1993;12(2):121-6. [PubMed:8324077].
14. Rahimi-Movaghar V, Eslami V. The major efficient mechanisms of ozone therapy are obtained in intradiscal procedures. Pain Physician. 2012;15(6):E1007-8. [PubMed:23159972].
15. Zhang Y, Ma Y, Jiang J, Ding T, Wang J. Treatment of the lumbar disc herniation with intradiscal and intraforaminal injection of oxygen-ozone. J Back Musculoskelet Rehabil. 2013;26(3): 317-22. doi: 10.3233/BMR-130386. [PubMed:23893147].
16. Ware JE. SF-36 health survey update. Spine (Phila Pa 1976). 2000;25(24):3130-9. doi: 10.1097/00007632-200012150-00008. [PubMed:11124729].
17. Bocci V, Borrelli E, Zanardi I, Travagli V. The usefulness of ozone treatment in spinal pain. Drug Des Devel Ther. 2015;9:2677-85. doi: 10.2147/DDDT.S74518. [PubMed:26028964]. [PubMed Central:PMC4440430].
18. Mysliwiec LW, Cholewicki J, Winkelpleck MD, Eis GP. MSU classification for herniated lumbar discs on MRI: Toward developing objective criteria for surgical selection. Eur Spine J. 2010;19(7):1087-93. doi: 10.1007/s00586-009-1274-4. [PubMed:20084410]. [PubMed Central:PMC2900017].
19. Gallucci M, Limbucci N, Zugaro L, Barile A, Stavroulis E, Ricci A, et al. Sciatica: treatment with intradiscal and intraforaminal injections of steroid and oxygen-ozone versus steroid only. Radiology. 2007;242(3):907-13. doi: 10.1148/radiol.2423051934. [PubMed:17209164].
20. Muto M, Ambrosanio G, Guarnieri G, Capobianco E, Piccolo G, Annunziata G, et al. Low back pain and sciatica: Treatment with intradiscal-intraforaminal O(2)-O (3) injection. Our experience. Radiol Med. 2008;113(5):695-706. doi: 10.1007/s11547-008-0302-5. [PubMed:18594765].
21. de Andrade RR, de Oliveira-Neto OB, Barbosa LT, Santos IO, de Sousa-Rodrigues CF, Barbosa FT. Effectiveness of ozone therapy compared to other therapies for low back pain: a systematic review with meta-analysis of randomized clinical trials. Braz J Anesthesiol. 2019;69(5):493-501. [In Portuguese]. doi: 10.1016/j.bjan.2019.06.007. [PubMed:31521383]. [PubMed Central:PMC9391853].
22. He R, Huang Q, Yan X, Liu Y, Yang J, Chen X. A case of paradoxical embolism causing anterior spinal cord syndrome and acute myocardial infarction following the intradiscal oxygen-ozone therapy. Front Neurol. 2019;10:137. doi: 10.3389/fneur.2019.00137. [PubMed:30853936]. [PubMed Central:PMC6395432].
23. Chirchiglia D, Chirchiglia P, Stroscio C, Volpentesta G, Lavano A. Suspected pulmonary embolism after oxygen-ozone therapy for low back pain. J Neurol Surg A Cent Eur Neurosurg. 2019;80(6):503-6. doi: 10.1055/s-0039-1685197. [PubMed:31430795].
24. Andreini I, Arrigucci U, Monti L, Bellini M, Battisti C, Federico A. A case of pneumocephalus as complication of ozone therapy: Diagnosis and treatment. Neurol Sci. 2020;41(2):481-3. doi: 10.1007/s10072-019-04062-4. [PubMed:31478149].
25. Vanni D, Galzio R, Kazakova A, Pantalone A, Sparvieri A, Salini V, et al. Intraforaminal ozone therapy and particular side effects: Preliminary results and early warning. Acta Neurochir (Wien). 2016;158(3):491-6. doi: 10.1007/s00701-015-2545-y. [PubMed:26293228].
26. Vanni D, Pappaccogli R, Pantalone A, D'Adamo D, Salini V (2016) Intraforaminal ozone therapy and particular side effects: All that glitters aren't gold. J Pain Relief. 2016;5:254. doi: 10.4172/2167-0846.1000254.
27. Hao K, Liu H, Yang Y, Zeng Q, He X. Analysis of the efficacy of ozone therapy on different types of lumbar disc herniation: A new guidance is coming? [abstract]. J Ozone Ther. 2019;3(4):26. doi: 10.7203/jo3t.3.4.2019.15506.
28. Mirzashahi B, Farzan M. Is late neurologic decompression effective in traumatic spinal cord injury? Report of two cases and review of the literature. J Orthop Spine Trauma. 2016;2(2): e5629. doi: 10.17795/jost-5629.
29. Moazen Jamshidi MM, Moharrami A, Mirghaderi SP, Sharifpour S, Mafi AR, Mortazavi SJ. The role of spinopelvic parameters in total hip arthroplasty: A current concept review. J Orthop Spine Trauma. 2022;8(2):40-3. doi: 10.18502/jost.v8i2.9308.
| Files | ||
| Issue | Vol 9 No 4 (2023) | |
| Section | Research Articles | |
| DOI | https://doi.org/10.18502/jost.v9i4.13931 | |
| Keywords | ||
| Ozone Intervertebral Disc Displacement Pain Quality of Life | ||
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How to Cite
1.
Golbakhsh M, Mirshahi M, Bozorgmanesh M, Ebrahimian M, Shafiei SH, Siavashi B, Mahdavi F, Fallah Y. Is Intradiscal Ozone Injection Effective in Ameliorating Symptoms of Lumbosacral Discopathy?. J Orthop Spine Trauma. 2023;9(4):167-70.
