Abstract
To compare technical success, clinical success, complications and radiation dose for percutaneous intradiscal ozone therapy in patients with lumbar disc herniation using fluoroscopic guidance versus conventional computed tomography (CT) guidance. Between March 2018and March 2021, 124consecutive percutaneous intradiscal ozone therapies wereperformedon111 patients with low back pain (LBP) and/or sciatic pain due to lumbar disc herniation, using fluoroscopic or conventional CT guidance, respectively in 53 and 58 herniated lumbar discs, with at least 1-month follow up. Dose area product (DAP) and dose length product (DLP) were recorded respectively for fluoroscopy and CT, and converted to effective dose (ED). Fluoroscopic and CT groups were similar in terms of patient age (p-value 0.39), patient weight (p-value 0.49) and pre-procedure Oswestry Disability Index (ODI, p-value 0.94). Technical success was achieved in all cases. Clinical success was obtained in 83.02% (44/53) patients in fluoroscopic group and 79.31% (46/58) in CT group. Mean DAP was 11.63Gy*cm2 (range 5.42-21.61). Mean DLP was 632.49mGy-cm (range 151.51-1699). ED was significantly lower in the fluoroscopic group compared toCT group (0.34 vs. 5.53mSv, p = 0.0119). No major complication was registered. Minor complications were observed in 4 cases (2 in fluoroscopic group; 2 in CT group). Compared to conventional CT guidance, fluoroscopic guidance for percutaneous intradiscal ozone therapy in patients with lumbar disc herniation shows similar technical and clinical success rates, with lower radiation dose. This technique helps sparing dose exposure to patients.
Highlights
Low back pain (LBP) is one of the most common and important clinical, social, economic, and public health problems affecting the human population worldwide [1]
Fluoroscopic and computed tomography (CT) groups were similar in terms of patient age (p-value 0.39), patient weight (p-value 0.49) and pre-procedure Oswestry Disability Index (ODI, p-value 0.94)
Clinical success was obtained in 83.02% (44/ 53) patients in fluoroscopic group and 79.31% (46/58) in CT group
Summary
Low back pain (LBP) is one of the most common and important clinical, social, economic, and public health problems affecting the human population worldwide [1]. The mechanism of lumbar pain is still not fully understood and seems to be multifactorial, considering pain as the result of compression, irritation, and chemical inflammation of peripheral nerves surrounding intervertebral discs [4, 5]. It is believed that disc herniation produces a mechanical stress on the adjacent nerve root causing the release of inflammatory cytokines, which makes the nerve root oversensitive to mechanical compression itself [6]. Magnetic Resonance (MR) is the method of choice for the diagnosis of radicular disc compression, allowing the analysis of all structures involved in LBP [7]. All treatments have the same rationale that consists in reducing disc volume and nerve root compression. The natural history of disc herniation is often favorable but symptoms may persist for long periods of time in around 37% of patients [1]
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