Discólisis con ozono intradiscal en el tratamiento de la ciática por hernia discal. Seguimiento de 100 pacientes en 24 meses

Abstract

Objective We performed a retrospective study to evaluate the safety and effectiveness of ozone discolysis in sciatica due to a contained herniated disc. Material and method This study included 100 patients with symptoms of intense lumbosciatic pain, visual analog scale (VAS) > 6 and onset more than 3 months previously, who were unresponsive to analgesics and systemic corticosteroids for a minimum period of 1 month and who showed signs of radicular pain and radiation to the affected dermatome. The radiological inclusion criteria consisted of magnetic resonance imaging (MRI) evidence of a contained herniated disc. The treatment applied consisted of the following: a first session with epidural administration of 10 ml of ozone at 30 μg/ml, 4 mg of triamcinolone and 5 ml of bupivacaine 0.25% plus paravertebral administration of 10 ml of O 3 at 30 μg/ml, 4 mg of triamcinolone and 5 ml bupivacaine 0.25% on the affected side; a second session between 7 and 10 days after the first, consisting of the same treatment; and a third session with intradiscal administration of 10-20 ml of O 3 at 50 μg/ml plus prophylactic antibiotic therapy. Analgesic efficacy was evaluated at 1, 3, 6, 12 and 24 months through VAS and radiological evaluation with MRI at 3, 12 and 24 months. A result was considered: a) excellent when the patient was asymptomatic and able to fully return to work and resume physical exercise and VAS decreased > 70%; b) good when the patient had occasional back or sciatic pain, with complete return to work, occasional use of analgesics and VAS decreased > 40%, and c) poor when there was insufficient symptom improvement, daily medication intake, limitation of physical activity, change of work and VAS decreased by > 40%. P values of < 0.05 were considered significant. Results Of the 100 patients, 91 could be evaluated at 24 months (52 men and 39 women). Age ranged from 26 to 77 years with a mean age of 52+7 years. By order of frequency, the vertebrae affected were L4-L5 (49%), L5-S1 (41%), L3-L4 (9%), other vertebrae (11%). By month, an excellent result was obtained in the following percentages of patients: 1 month 95.6%; 3 months 91.3%; 6 months 90.7%; 12 months 87.7%; 2 and 24 months 81.1%. MRI showed a significant reduction in hernia volume in 79% of the patients. A second discolysis was required by five patients who were excluded from the study. There was one case of discitis and 11 cases of postpuncture headache (all in patients with L5-S1 discolysis) and four cases of lumbar pain requiring analgesic treatment. Thirty-two percent of the patients took paracetamol irregularly for lumbar pain. Patients requiring other types of medication were withdrawn from the study. Conclusions Intradiscal ozone administration in the protocol described achieved early onset of pain reduction, which was maintained for more than 2 years, as well as a sustained reduction in hernia size produced by ozone.