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The objective of these
clinical case studies is to demonstrate the therapeutic effectiveness of ozone
therapy in cases of hernial discs and vertebral arthrosis in the lumbar sacral
region.
A total of 4 patients were
chosen: Two diagnosed with lumbar disc herniation; and two with discartrosis in
the lumbar sacral region, at Ozonocenter Medical Center in Quito-Ecuador, in
the second half of 2016.
Patients showed clear
clinically signs of the disease: lumbar pain, gluteal pain, lumbar pain at
walking and pain when sitting for too long. Nuclear magnetic resonance studies
(MRI) of the lumbar sacral region were used to corroborate the presence, type
and size of the illness before and after the treatment.
All four patients, showed
size reduction of the protrusions discs and discartrosis improvement. A monthly
follow-up with these patients was done during six months; they all remained
asymptomatic during this period.
In conclusion, ozone therapy
is an excellent medical procedure for the resolutions of disc protrusions and
discartrosis at the lumbar sacral level.
Keywords: Disc herniation, Lumbar sacral region, Discartrosis, Ozone therapy,
Protrusions, Nuclear magnetic resonance (MRI).
INTRODUCTION
Ozone in
column discopaties accelerates the degradation of polyglucosides in the nucleus
pulposus of the intervertebral disk which leads to its reabsorption, with the
consequent reduction of the herniated material responsible for nerve
compression. Ozone also eliminates the chemical mediators of inflammation
(Fospolipasa A2, Metalloproteinases, Prostaglandin E2, IL6, Glycoprotein
YKL-40) that are released with the rupture of the nucleus pulposus of the
injured disk and cause inflammation, muscle contracture, lack of irrigation
(tissue hypoxia, ischemia, and acidosis), local edema, demyelination and
nociceptive stimulus (pain). Ozone stimulates the action of the growth factor
(TGF-B) favoring the regeneration of tissues. It increases the ability of the
blood to absorb and transport oxygen (hyperoxygenation) improving micro
circulation and cellular functions, decreasing edema, regulating the cellular
Redox balance and neutralizing the free radicals of oxygen [1-5].
MATERIALS AND METHODS
This
study was reviewed and approved by the Ozone Center Ethics Committee;
it complied with the Helsinki Declaration requirements, latest version -
General Assembly of Edinburgh, Scotland, October 2000 [6]. The following
technique was used with all patients: After disinfecting the area, we did an
infiltration of the compartment of the psoas or Bonitot space, with 15 cc of
ozone at a concentration of20 ug/cc, 4 cm from the spinous process at
intercrestas iliac or Tuffier line level which corresponds to L4, following the
technique of Capdevilla or modified Nizora, defining the infiltration side
based on the location of the lumbar problem or paresthesia in the lower limb in
case of Radiculopathy. Very thin needles were used, No. 22 x 7 cm [7].
The longer
needles and therefore deeper infiltrations are aimed at reaching the emergency
of the radicular nerve root and the site of infiltration (right or left)
depends on the place where is located the conflict root disk (pain,
paresthesias in the buttock, leg, foot) corresponding.
Studies
of magnetic resonance imaging (MRI) of the lumbo sacral region were used to
corroborate the evolution of the injuries at the end of the treatment. The characteristics of the pain and
further details of the examination, was not evaluated for not being a reason
for the study.
Case 1: Female, 42 years, medical doctor, presents
pain in lumbar area that increases when standing for too long, pain becomes
disabling at night. When applying the digit lumbar intervertebral pressure
(Delitala sign), patient presents pain in the sacroiliac joints. No signs of
root compression. Since the second Ozonetherapy session, the symptomatology was
gradually diminishing, until it disappeared completely. Post-treatment MRI
showed a complete reduction of the discal protrusions at L4/L5 and L5/S1. (Figure 1,2)
Case 2: Male, 25 years old, student, presents intense
back pain with radiation to left lower limb, associated with paresthesia’s that
went through his toes. When doing physical examination, patient presented low
back pain, left positive Lasègue, decreased patellar reflex, positive Semmes
Weinstein test (monofilament) on left foot. After the fourth Ozone therapy
session, pain started to decrease until it disappeared as verified in the
subsequent tests. Also since the sixth session, patient showed recovery of
touch sensation in his left foot, improving ambulation. The MRI done at the end
of the therapy evidenced a significant reduction of Herniated discs L4/L5 and
L5/S1. (Figures 3,4)
Case 3: Female, 49 years old, housewife, history of
low back pain for several years, diagnosed with herniated disc. Presents
intense lumbar pain that increases when getting out of bed, standing or sitting
for a long time. Lumbar flexion accentuates the pain.After physical
examination, painful facies is evident, there is pain pressure in the lumbar
region and right Lasegue. Monofilament test is negative on both feet. Patient
started showing gradual pain relief, until she became asymptomatic in the
subsequent tests. Post-treatment MRI showed a significant improvement on her
discarthrosis, even with vertebral disc L4/L5 regeneration and resolution of
the L5/S1 disc protrusion and Schmorl nodes. (Figures 5,6)
Case 4: Male, 60 years old, lawyer, presents
important back pain especially when practicing sports which radiates to left
lower limb which limits his daily activities. Physical examination shows
intervertebral lumbar pain and left Lasègue. Monofilament test is negative on
both feet. By the end of the therapy, MRI shows an absolute improvement on the
discarthrosic phenomenon, patient remains asymptomatic and returns to his
day-to-day work (Figures 7,8)
DISCUSSION
In the
past couple of years, Ozone therapy has developed as an effective therapeutic
method, being recognized and used in various countries around the world. There
are currently more than 40 national and international associations that bring
together professionals who practice this therapy. One of the most recent
achievements was to unify criteria in terms of methods and procedures to follow
in the "Madrid’s Declaration of
Ozonetherapy ", signed in Madrid, Spain (June 2015) during the
international meeting of Ozone therapy schools. It is currently the only
existing global document on ozone and its recommendations are implemented
around the world [8].
Ozone
treatments are considered modern therapies of great utility in multiple
pathologies; they have great results in herniated discs at the lumbar area.
This technique is based on the infiltration of ozone in the paravertebral
muscles adjacent to the injury and/or the emergence of the nerve roots that
form the spinal/sciatic nerve. Psoas or Bonitot space chamber infiltrations
along with Capdevilla or modified Nizoratechnique, help block and reduce the
pain, symptoms and size of the herniated material by ceasing the compressive
effect [9-11].
A recent
meta-analysis showed that ozone therapy is as effective as surgery, with much
less adverse events and also less expensive. It is currently one of the best
options to treat Herniated disc pain, with the advantage of being an outpatient
treatment. The benefits are long-lasting and there aren’t adverse results if the
technique is well used [12].
There are
discolysis techniques with ozone, which must be carried out in an operating
room with the support of sedation and fluoroscopy equipment to guide needles
puncture. These techniques are more expensive and their benefits do not exceed
the ones of paravertebral ozone infiltration [13-16].
On a
Meta-analysis done by Steppan J. on 2010, he studied the use of ozone in
Herniated discs cases and concluded that the technique of intradiscal ozone
therapy or intraforaminalhas an II-3 level of evidence; while the technique of
paravertebral ozone has an II-1 level of evidence [17].
The analysis carried out at Ozone Medical Center confirms the results observed by other authors, ozone reduces the size of the discal protrusions and discartrosic vertebral lesions, as well as the symptomatology. In conclusion, the paravertebral ozonetherapy, constitutes an excellent medical procedure for Herniated discs and spinal discarthrosic; providing patients a better quality of life. Further studies on this matter are needed to establish treatment protocols.
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