Intradiscal ozone therapy for the treatment of disk herniation.
Pérez A. and Menéndez S. (Cuba)

In many painful diseases and especially in the presence of inflammatory processes, ozone therapy has been used with very good results. Spinal diseases are the most common cause of disability in persons under the age of 45. The aim of this paper is to evaluate the efficacy of intradiscal ozone therapy in the treatment of lumbar and cervical disk hernia. We studied 45 patients (of both sex), with 6 months follow-up at least, 30 suffering of lumbar hernia (L5 - S1, 16 patients and L4 - L5, 14 patients) and 15 with cervical hernia (C6 - C7, 9 patients and C5 - C6, 6 patients). All of them were preliminarily submitted to clinical examination, electromyography, CT and MRI. After local anesthesia, we injected the disk, with 18 - 20 G needles (15 cm of length), under fluoroscope guidance, with 10 mL (cervical hernia) or 15 mL (lumbar hernia) of a mixture of oxygen and ozone at a concentration of 20 - 25 mg/L. The treatment was repeated two to ten times, once per week, in dependence of the pain elimination. At the end of the treatment, physical exam, neurologic and orthopedic tests were performed. CT follow-ups were carried out 4 months later. Signs and symptoms of disk herniation are caused by compression of either nerve roots or the spinal cord. The specific signs and symptoms are based on which part is compressed and at which level the neural structures are compressed. The total resolution of the symptoms was achieved in 88 % of patients. An attenuation of the symptoms, without interference with the patient daily activities, were obtained in the rest of the patients (12 %) treated. Patients with no benefits, 0 %. No patients underwent surgery after the treatment. Cervical hernia needed less ozone therapy sessions to eliminate the pain (between 2 - 4 sessions), however lumbar hernia needed between 6 and 10 sessions to obtain the same results. A great advantage of this method is that practically has no contraindications and it does not require hospitalization. Ozone therapy has shown to be a promising therapy for patients with herniated intervertebral disks and a valid alternative to surgery in many cases.

Paravertebral ozone therapy in sacrolumbar pain produced by disk hernias.
Benítez P.P. and González Y. (Cuba)

The aim of this study was to evaluate the effectiveness of the paravertebral ozone therapy, as a method for low back pain treatment that take place by disk disruption. We study 300 patients, divided at random in five groups of 60 patients each:

0.      Group A: Epidural Steroids (control group)

0.      Group B: Epidural Ozone

0.      Group C: Paravertebral Ozone

0.      Group D: Outforaminal Ozone

0.      Group E: Intradiscal Ozone

We show in this report that the patients treated with epidural steroids enjoyed only a transitory relief of the pain. However, 95 % of the patients treated with Ozonoterapy had a permanent relief of the pain during the time of evaluation (12 months) and 92 % remained incorporated to their habitual activities.

Oxygen ozone therapy in disk toot compression: Experience in Puebla, Mexico.
Melgarejo A., Arroyo M.L., Moreno V. and Ríos A. (Mexico)

Root compression by an herniated disk is the most common cause of acute or subacute lumbar pain. The use of oxygen ozone therapy has been reported previously as a good alternative treatment. We report our experience in Puebla, Mexico. In this prospective study, we report our initial experience obtained in 32 patients, whom were resistant to conservative treatment for pain caused by herniated or protruded lumbar disks, central or foraminal, demonstrated by clinic, CT and/or MR imaging, electrophysiology and discogram. All patients received during a period of 3 weeks, 8 sessions of a bilateral paraspinal intramuscular injection of 10 mL of oxygen ozone at a concentration of 27 ng/mL at the sensitive level, as well as, 7 - 12 mL of oxygen ozone directly in the disk, this after performing a discogram, to verify the diagnosis and exclude a vascular or arachnoid communication or a major leak, 49 % of cases at the L4/5 level, 39.6 % at the L5/S1 level and 11.3 % at L3/4. All patients entered a lumbar muscular strenghthening program and used an external support. The clinical benefits were immediate in 24 patients (75 %) with total or almost total resolution of symptoms, good results in 6 (18.7 %) and minimum or no benefit in 2 (6.2 %). Recurrence of symptoms presented in 2 patients at 6 months, and in 3 at 10 months, undergoing therefore a second trial, with good results. To this moment, our results are encouraging as to the effectiveness of the use of oxygen ozone therapy in patients resistant to conservative treatment for pain caused by lumbar root nerve compression.

Intradiscal ozone for the treatment of herniated disk. Discolysis
De Lucas-García J.C. and De Lucas-Villarubia J.C. (Spain)

We present our experience in the treatment, using intradiscal ozone, of 100 consecutive cases of cervical and lumbar symptomatic herniated disks (94 patients), treated in our Institution, since November 1999, with a minimum follow-up of 6 months. The patients were evaluated before treatment, at the end, and in the follow-up, using a personal clinical score, based on the one of Lassale (1984) for evaluation of spinal stenosis. Pain was evaluated using an analogous scale for the evaluation of pain (VAS). At the end of the treatment a subjective assessment was carried out. The results demonstrated that at the end of the follow-up we obtained a 83 % of good and excellent clinical results, with just 8 patients needing a surgical procedure (poor result). Pain improved from 3.19 points (severe pain, with no response to medical treatment) to 8.18 points at the end of treatment (moderate pain, does not need medical treatment) and 8.66 points at the last follow-up (mild pain), with 27 patients scoring 10 points (no pain). At the last revision, 85 patients (90 %) were satisfied with the treatment and in similar circumstances, 83 patients (88 %) would repeat it. These data suggest that intradiscal application of ozone is a valid option for treatment of symptomatic herniated disk, with good results and almost absence of complications.

A comparative study between the clinical behavior and the RMI scan resolution in patients undergoing ozone therapy due to acute disk herniation with root compression.
Ríos J.M., Grangeat A., Pérez A. and Croce E. (Argentina)

The treatment of the acute herniation disk can be approached through various methods, some of them being non-surgical like discolisis with oxygen-ozone therapy (O2-O3). The aim of this paper is to analyse the progressive changes occurring in the RMI and the absence of correlation between the former and the clinical improvement of the symptoms in patients undergoing ozone therapy due to acute disk herniation with root compression. Between April 2002 and December 2003, 122 patients with herniation disc pathology underwent oxygen-ozone therapy discolysis. Fourty of them with acute herniation lumbar disk, of whom 28 (70 %) were male and 12 female (30 %). Mean age: 36.89. A hundred percent complained about pain which resulted in: social behaviour changes 30 (75 %), wakefulness 28 (70 %), amusement disturbances 20 (50 %), sexual disturbances 16 (40 %). Other minor disorders were sensory changes like disesthesia, paresthesia, or anaesthesia). Radiology diagnosis was utilised in all cases by means of RMI. Twenty two out of 40 (55 %) had involved L5-S1 space. Heigth (20 %) L4-L5, 6 (15 %) L3-L4, and 4 (10%) had more than one level involved. Test on pain and influence on various aspects were run, which resulted in a pain index inability (IDD). Both RMI and IDD results were later compared. These patients underwent 10 sessions of O2-O3, two of which consisted of 6 mg/dose and 8 of 30 mg/dose. After the treatment, further tests were performed and new IDD results were obtained. These results were later classified as follows: Excellent (35 %); Very Good (50 %); Good (10 %), fairly good (5%) and failure (0%). In fact, ozone-therapy results in an improvement in the disc-nerve root conflict and in the overall clinical picture. Such achievement is independent of the mechanical factor changes, which will take place only later in time (6 - 12 months). It can be clearly observed that patients have improved their symptoms independently of the RMI changes, which occur only six month after ending the treatment. Pain resolution and its concomitant disabilities is the aim of the treatment in patients with acute disc herniation.