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Five and ten year follow-up on intradiscal ozone injection for disc herniation.

Buric J, Rigobello L, Hooper D - Int J Spine Surg (2014)

Bottom Line: We conclude that ozone is safe and effective in approximately 75% of patients with disc herniation and the benefit is maintained through ten years.The benefit of ozone is durable and does not preclude future surgical options.The risk reward profile for this treatment is favorable.

View Article: PubMed Central - PubMed

Affiliation: Villa Torri Hospital, Bologna, Italy.

ABSTRACT

Background: Disc herniation is the most common cause for spinal surgery and many clinicians employ epidural steroid injections with limited success. Intradiscal injection of ozone gas has been used as an alternative to epidural steroids and surgical discectomy. Early results are positive but long-term data are limited.

Methods: One hundred and eight patients with confirmed contiguous disc herniation were treated with intradiscal injection of ozone in 2002-2003. One-hundred seven patients were available for telephone follow-up at 5 years. Sixty patients were available for a similar telephone follow-up at ten years. Patients were asked to describe their clinical outcome since the injection. Surgical events were documented. MRI images were reviewed to assess the reduction in disc herniation at six months.

Results: MRI films demonstrated a consistent reduction in the size of the disc herniation. Seventy-nine percent of patients had a reduction in herniation volume and the average reduction was 56%. There were 19 patients that ultimately had surgery and 12 of them occurred in the first six months after injection. One of these 12 was due to surgery at another level. Two surgeries involved an interspinous spacer indicated by stenosis or DDD. All other surgeries were discectomies. Of the patients that avoided surgery 82% were improved at 5 years and 88% were improved at 10 years. Other than subsequent surgeries, no spine-related complications were experienced.

Conclusions/level of evidence: We conclude that ozone is safe and effective in approximately 75% of patients with disc herniation and the benefit is maintained through ten years. This is a retrospective review and randomized trials are needed.

Clinical relevance: Intradiscal ozone injection may enable patients to address their pain without multiple epidural injections and surgery. The benefit of ozone is durable and does not preclude future surgical options. The risk reward profile for this treatment is favorable.

No MeSH data available.


Related in: MedlinePlus

Time course of operations following ozone treatment. The blue line represents actual responses from patients contacted. The red line indicates a worst-case scenario where all patients lost to follow-up went on to surgery.
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Figure 0001: Time course of operations following ozone treatment. The blue line represents actual responses from patients contacted. The red line indicates a worst-case scenario where all patients lost to follow-up went on to surgery.

Mentions: Of the original cohort of 108 patients, 107 were evaluated at 5 years. Twenty-six of the patients could not be reached at ten years (mainly to phone number change) and another 3 had deceased for reasons unrelated to their spine surgery. Records were reviewed thoroughly at the 5-year follow-up and 19 patients required surgery. Seventeen of the 19 surgeries were discectomies and two were interspinous spacers. Twelve of the 19 operations occurred within the first six months. One discectomy was performed at 22 months due to a herniation at another level. There were two cases of monosegmental stenosis at 51 months and 61 months, respectively, that were treated with interspinous spacers. The timing of these operations is provided in Figure 1. Overall, there were 16 discectomies at the affected level in 108 patients at 5 years (15%) plus two cases of DDD/stenosis. The ten year phone interviews did not identify any additional surgeries in the patients we were able to contact.


Five and ten year follow-up on intradiscal ozone injection for disc herniation.

Buric J, Rigobello L, Hooper D - Int J Spine Surg (2014)

Time course of operations following ozone treatment. The blue line represents actual responses from patients contacted. The red line indicates a worst-case scenario where all patients lost to follow-up went on to surgery.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4325503&req=5

Figure 0001: Time course of operations following ozone treatment. The blue line represents actual responses from patients contacted. The red line indicates a worst-case scenario where all patients lost to follow-up went on to surgery.
Mentions: Of the original cohort of 108 patients, 107 were evaluated at 5 years. Twenty-six of the patients could not be reached at ten years (mainly to phone number change) and another 3 had deceased for reasons unrelated to their spine surgery. Records were reviewed thoroughly at the 5-year follow-up and 19 patients required surgery. Seventeen of the 19 surgeries were discectomies and two were interspinous spacers. Twelve of the 19 operations occurred within the first six months. One discectomy was performed at 22 months due to a herniation at another level. There were two cases of monosegmental stenosis at 51 months and 61 months, respectively, that were treated with interspinous spacers. The timing of these operations is provided in Figure 1. Overall, there were 16 discectomies at the affected level in 108 patients at 5 years (15%) plus two cases of DDD/stenosis. The ten year phone interviews did not identify any additional surgeries in the patients we were able to contact.

Bottom Line: We conclude that ozone is safe and effective in approximately 75% of patients with disc herniation and the benefit is maintained through ten years.The benefit of ozone is durable and does not preclude future surgical options.The risk reward profile for this treatment is favorable.

View Article: PubMed Central - PubMed

Affiliation: Villa Torri Hospital, Bologna, Italy.

ABSTRACT

Background: Disc herniation is the most common cause for spinal surgery and many clinicians employ epidural steroid injections with limited success. Intradiscal injection of ozone gas has been used as an alternative to epidural steroids and surgical discectomy. Early results are positive but long-term data are limited.

Methods: One hundred and eight patients with confirmed contiguous disc herniation were treated with intradiscal injection of ozone in 2002-2003. One-hundred seven patients were available for telephone follow-up at 5 years. Sixty patients were available for a similar telephone follow-up at ten years. Patients were asked to describe their clinical outcome since the injection. Surgical events were documented. MRI images were reviewed to assess the reduction in disc herniation at six months.

Results: MRI films demonstrated a consistent reduction in the size of the disc herniation. Seventy-nine percent of patients had a reduction in herniation volume and the average reduction was 56%. There were 19 patients that ultimately had surgery and 12 of them occurred in the first six months after injection. One of these 12 was due to surgery at another level. Two surgeries involved an interspinous spacer indicated by stenosis or DDD. All other surgeries were discectomies. Of the patients that avoided surgery 82% were improved at 5 years and 88% were improved at 10 years. Other than subsequent surgeries, no spine-related complications were experienced.

Conclusions/level of evidence: We conclude that ozone is safe and effective in approximately 75% of patients with disc herniation and the benefit is maintained through ten years. This is a retrospective review and randomized trials are needed.

Clinical relevance: Intradiscal ozone injection may enable patients to address their pain without multiple epidural injections and surgery. The benefit of ozone is durable and does not preclude future surgical options. The risk reward profile for this treatment is favorable.

No MeSH data available.


Related in: MedlinePlus