Ozone Therapy for Back Pain: Ozone Nucleosis
Low back pain is a very disturbing symptom that can affect about 80 % of the world’s population. It is probably experienced by nearly everyone at some point in his or her life. In 90% cases it resolves spontaneously within 4 weeks with or even without any treatment. In most cases, physical therapies such as exercises, manipulation therapy can solve the problem.
However, if a herniated disc, that is the protrusion of the nucleus pulposus through the annulus fibrosus, is present and causes considerable pain, it must be removed with the least invasive procedure. All forms of treatment aim at decompressing the disc, foramen and the nerve root.
These can be done by taking the disc out and decompressing the foramen by surgery. Surgery has the risk that sometimes patients loose partial or total working abilities, deteriorating their quality of life. Though different treatments (conservative and surgical) exist for patients suffering from herniated disc, sometimes they failed.
Experimental models have demonstrated that the extruded nucleus pulposus can produce a chemical and immunological irritation of the radicular nerve, causing inflammation.
There are anatomic, mechanical compression, vascular, immune, inflammatory and neural factors responsible for disk-radicular conflict symptoms. 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.
Mechanism of Ozone action
• Ozone’s action is due to the active oxygen atom (singlet oxygen) liberated from it.
• It attaches with the proteo-glycan bridges in the nucleus pulposus causing its degradation
• They are broken down and are no longer capable of holding water.
• This causes dehydration and resorption of the disk hernia.
• As a result disc shrinks and mummified and there is decompression of nerve roots.
• Ozone has analgesic and anti-inflammatory effects as it modifies mediators of inflammation and pain
Ozone Nucleolysis: the procedure
• Percutaneous injection of ozone-oxygen mixture is given with a 22 G spinal needle under fluoroscopy control.
• Conc. Of ozone is 29-30 microgram /ml.
• Ozone gas is injected immediately from an ozone generator.
• 3-10 ml of ozone is injected at the centre of the disc
• With/without intraforaminal injection.
• Procedure is performed under CT or C-Arm guidance.
Benefits of Ozone Nucleolysis Treatment
• It is a minimally invasive treatment with a negligible cost and rare side effects.
• A great advantage of this method is that practically it has no contraindications and it does not require hospitalization.
• An attenuation of the symptoms, and resumption of daily activities in over 80 % of patients.
• It produced an improvement of the clinical and biochemical parameters measured and also of the imaging.
• This technique in specialist hands is relatively easy.
• Some relapses could appear after two years of the treatment.
• Not a single serious life-threatening complication was found in over 200,000 cases of Ozonucleolysis in different centers of European countries.
Careful selection of the patients is required. While selecting patients for Ozone therapy, following cases are excluded.
• Possible fracture
• Possible tumor or infection.
• Bladder or Bowel dysfunction.
• Severe or progressive neurologic dysfunction in the legs.
• Major motor weakness in quadriceps, plantar flexors, evertors, and dorsiflexors.
Ozone Nucleolysis is a Percutaneous procedure almost devoid of serious complications but a high success rate of nearly 90% and with a low recurrence rate.
At Citi Vascular Centre, Ozone disc nucleolysis cases conducted by the Dr. Shaileshkumar Garge, consultant interventional radiologist.
Ozone Therapy in OsteoArthritis:
Causes of osteoarthritis
• Mechanical forces leading to wear and tear
• Along with Mediators of pain in Chronic inflammatory reaction
• Edema and inflammation leading to ischemia
• Collagenase and proteoglycanases secreted by activated chondrocytes and monocytes leading to matrix degeneration, softening and destruction of knee joint
Mode of administration
Ozone therapy is given in the form of Injections under aseptic precautions around the knee (Peri articular Injections) and inside the knee joint (Intra articular)
Peri articular injections are given for 10 to 15 sittings or intra articular injections are done for 3-5 sittings
Mechanism of action of Ozone
• Proteolytic enzymes and endogenous ROS are inhibited
• Bradykinin and inflammatory PG release is inhibited
• Release of immunosuppressive cytokines TGF-beta and IL-10 may inhibit inflammation
• Disappearance of edema leads to improved circulation, washing away of lactic acid and relief in pain
• Ozone injections act as an analgesic
• Algic stimulation of skin can reduce pain through mechanism of Diffuse Noxious Inhibitory Control
• H2O2 may cause irreversible damage and death of nociceptors; consequently activation threshold