Role of Intradiscal Ozone in Treatment of Contained Prolapsed Intervertebral Disc: A Prospective Cohort Study of 62 patients

Abstract

Introduction Prolapsed intervertebral disk is a common cause of lumboradicular and cervicoradicular pain. Various modality of treatment are available ranging from conservative treatment to surgery. However there is a large patient population that is not cured by conservative treatment and are not candidates for surgery or refusing surgery. The purpose of this study is to evaluate the role of intradiscal ozone in such patients. Materials and Methods A prospective study was set up from 2008–2010, and included patients treated with single level intradiscal ozone therapy for herniated or protruded disk pathology. Only patients with a clinical and MRI diagnosis of a prolapsed disk, who failed a conservative trial of 3 months, were not surgical candidates or refused a surgical line of treatment were included in the study. Total of 62 patients, 41 males and 21 females with a mean age of 41.5 years (21–56), were selected. Total 40 lumbar and 22 cervical disks were treated. Disk levels involved were 22 L4-5, 17 L5-S1, 1 L3-4, 13 C5-6, 6 C6-7, and 3 C4-5. All patients had symptoms of radiating pain to the limb. Preoperatively, Oswestry disability index(ODI) and visual analogue scale(VAS) for leg pain were obtained for lumbar disks, and Vernon and Mior Neck disability Index (VMNDI) were obtained for cervical disks. All patients underwent an intradiscal ozone injection (30 mm of ozone) in the pathological disk under sedation and local anesthesia, and patients with severe radiating pain were also given nerve root ozone injection. The injection was carried out in a cardiac cath lab for better visualization of the disk space. All patients were advised rest for 2 days and were given physiotherapy for 10 days postinjection. They were allowed to go to work from the third day postinjection. Patients were evaluated at 1, 3, 6, and 12 months and then 6 monthly. Results The mean follow-up was 19.23 months (14 to 32 months). The preoperative ODI and VMNDI combined scores improved from a mean of 62.84 to 10.29% at 1 month and mean 7.8% at the final follow-up. VAS for leg pain improved from a mean of 4.28 preoperatively to 0.82 mm at 1 month and 0.42 at the final follow-up. Two patients required a repeated injection at 3 months. Three patients were lost to follow-up. Two patients who were advised surgery but refused did not improve clinically postinjection and were then operated upon. No complications were noted except a mild headache in six patients postinjection. Rest of the patients had pain relief better than with conservative treatment and stopped taking analgesics post 1 month from the procedure. There were no cases of recurrent disks. Conclusion Intradiscal ozone injection is effective in the treatment of prolapsed intervertebral disk pathology. In patients not responding to conservative therapy and refusing surgery or patients who are not good surgical candidates, ozone injection therapy can be safely administered to relieve symptoms. Intradiscal ozone injection treatment can be used as a middle path between conservative and surgery in the treatment module of prolapsed intervertebral disk pathology. I confirm having declared any potential conflict of interest for all authors listed on this abstract No Disclosure of Interest None declared