Spinal Pain

It is one of the commonest experiences of humankind. Point prevalence is approximately 50%. It is probably experienced by nearly everyone at some point in his or her life.

Spinal Pain
In 90% cases it resolves spontaneously within 4 weeks regardless of treatment, or even without any treatment.

Red Flags
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.

Spinal Pain

The remaining 10% of adults represents one of the greatest challenges to conventional medical treatment.

Spinal Pain

Approx 5-6% of total sufferers needs more invasive therapeutic modalities, ending in one or more surgeries to obtain pain relief.

Prolapsed IV Disc:History
Since it was first diagnosed by Dandy & then by Mixter and Barr over 70 years ago it has been implicated as major cause of low back & neck pain, which are not responding to the conservative therapy.

PID:Treatment options Decompression of nerves

These can be done by taking the disc out and decompressing the Nerves by surgery. Decompression by different interventions.

Different Interventions
Epidural Steroid Inj. Epidurogram & Epidurolysis. Nerve root sleeve/ transforaminal Inj. Intra-discal steroid inj. Nucleoplasty Chemo-nucleolysis with Chymopapain Ozone Discolysis

PID:Treatment options
The various treatment options has confused clinicians and investigators due to high failure rate and complications associated with different kinds of surgeries and interventions.

Failure rates
Different types of surgeries: 10 to 51% Ozone Discolysis: 10 to 21%

Ozone Discolysis
A safer alternative to Chemonucleolysis, other interventions and disc surgery. It has high success rate (nearly 90%). It is less invasive. Fewer chances of recurrences. Remarkably fewer side effects.

Ozone Discolysis: How it acts?

Its action is due to the active oxygen atom (singlet oxygen) liberated from it. It attaches with the proteo-glycan bridges in the nucleus pulposus. They are broken down and they no longer capable of holding water. As a result disc shrinks and mummified and there is decompression of nerve roots.

Ozone Discolysis: selection criteria

Must have H/O failed conservative treatment for more than 4 weeks. Must have positive CT/MRI scan. Do not have red flag signals

Ozone Discolysis: the procedure

Percutaneous injection of ozone-oxygen mixture. Conc. Of ozone is 29-30 microgram /ml. Ozone gas is injected immediately from an ozone generator. 3-4 ml of ozone is injected at the centre of the disc with/without intraforaminal injection. Procedure is performed under CT or CArm guidance.

Ozone Nucleolysis: safety profiles

Not a single serious life-threatening complications was found in over 1,20,000 cases of Ozone Discolysis in different centers of European countries.

Ozone Discolysis: safety profiles

In a multi-centre, retrospective 3 year follow-up study of lumber disc herniation treated with European Neurosurgical Institute protocol of ozone therapy in 917 patients showed 78.9% good & excellent results with only one case of disc infection which healed with antibiotic.

Our experiences
224 cases of Ozone Discolysis has been done with 3 months follow up. 196 cases had good to excellent results in 3 months follow up. 12 patients did not respond. 16 patients responded but pain came back between 2- 8 weeks. No major complications in any patients. So 87.5% had good to excellent results.

Comparison:
1. 2.

Spinal Surgery
More Hospital Stay. Complications of prolonged surgery & anaesthesia. Chance of failed back surgery syndrome Costly Failure rate 10-51% Safety profile compared to Ozone Discolysis is not so high. Repeat surgeries are more complicated.

Ozone Discolysis
1. 2. 3. 4. 5. 6. 7.

One day/Day Care. GA is not required. No chances of failed back surgery syndrome Cost is 1/5th to 1/10th Comparable 10-21% Very high safety profile. May be repeated many times without significant complications.

3. 4. 5. 6.

7.

Other uses in Pain Management

Ozone used as tissue proliferant in a conc. of 5-10micgr./ml. Used in Osteo-arthritis of knee. Ozone has a strong anti-inflammatory property and used as trigger point inj. In Fibromyalgia & Myofascial Pain. Used in Rheumatoid Arthritis.

summary
Spinal Pain is a very common sufferings, most of which resolves spontaneously with/without any treatment. Those who are not improved by 4 weeks are a challenge to the medical community. Many of these suffers from PID

summary
There are diff. Surgeries & diff. Interventions to treat PID Ozone Discolysis is a Percutaneous procedure almost devoid of serious complications but a high success rate of nearly 90%, with a low recurrence rate, less hospital stay & much economical compared to surgeries.

Thank you