Ozone injections for herniated disc. Prolozone used for chronic back pain from disc damage.

20 Feb Ozone injections for herniated disc. Prolozone used for chronic back pain from disc damage.

Below you will find some technical information on the use of ozone injections into and round the spinal discs of the back to promote recovery from chronic back pain. Ozone is being widely used and accepted as an alternative treatment to surgery and may be much better option due to it’s less invasive approach. It is more widely used out side of the USA due to political power of the surgical and pharmacology influences that govern the education and exposure to medical professionals here. There are 2 approaches the direct and the indirect approach.

The direct approach is carried out under radioscopic control: the needle is

inserted in the centre of the pathologic intersomatic space just before direct

insufflation of the gas mixture.  An expert can do it in about 10

min. After a rest of 10-15 min, the patient can get up and often he/she is

amazed by the disappearance of the pain, as occurs after nucleoplasty. If

necessary, the application can be repeated a second time before changing the

approach.

Good results have been obtained after either intradiscal or intraforaminal

injection of a variable volume (3-15 ml) of gas at an O3 concentration of 27-

30 mcg/ml. Several thousand patients have been treated, with a success rate

of 54-86% ( Jucopilla et al., 2000; Bonetti et al., 2001; Fabris et al., 2001;

Petralia et al., 2001; Alexandre et al., 2002). An extensive study had been

performed in 600 patients, who had failed to respond to conservative

management (Andreula et al., 2003): 70.3% of the first half of patients,

treated only with ozone, showed a good outcome. This was further improved

(78.3%) in the remaining 300 patients, by combining ozone treatment with a

periganglionic injection of corticosteroid and anaesthetic. Unfortunately

controls (either oxygen or oxygen-corticosteroid-anaesthetic alone) were not

evaluated, probably, for ethical reasons. Nonetheless, from a scientic point

of view, it will be important to perform a randomized study to evaluate the

role of the needle, oxygen and so forth, which are probably relevant.

It remains unclear how ozone acts. One real possibility, previously

discussed at length (Bocci 1998a, 1999), is that ozone dissolves in the

interstitial water and reacts immediately, generating a cascade of ROS,

among which H2O2 and possibly the hydroxyl radical, which is most

reactive. The hydroxyl radical can react with carbohydrates and amino acids

composing proteoglycans and collagen type I and II, major components of

the degenerate nucleus pulposus, leading to its breakdown (McCord, 1974;

Curran et al., 1984; Hawkins and Davies, 1996; Bocci et al., 2001b;

Leonardi et al., 2001). These studies, as well as those performed on human

blood, have been carried out using the Electron Paramagnetic Resonance

(EPR) spin trapping technique (Ueno et al., 1998; Bocci et al., 2001b).

Consequently, reabsorption of hydrolytic products and water may lead to

progressive shrinkage and disappearance of the herniated material. Reduced

mechanical irritation decreases the sensitivity of nerve axons, but

nociceptors are also excited by endogenous algesic substances released

during perineural ischaemia or neural inflammation present in the spinal

ganglion and neural roots (Willis, 1995). Thus, more than the mechanical

compression as primum movens, it is the inflammatory reaction that

sustains chronic pain by releasing PLA2, several proteinases and

cytokines. The continued release of ROS, PGE2, serotonin, bradykinin,

cathepsins, IL-1, IL-6, substance P and TNF alpha causes oedema, possibly

demyelination and increased excitability of nociceptors (Fields, 1986).

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Indeed, it has been observed that, in absence of inflammation, even a large

hernia can be painless. Moreover, the hernia may remain after an operation

(as seen radiographically), but the pain disappears once the inflammatory

disorder dies down. Interestingly, epidural injections of the antiinflammatory

methylprednisolone transitorily improve leg pain and sensory

deficits in patients with sciatica due to a herniated disc (Carette et al., 1997).

Table 7 intends to summarize the complex reparative process induced by

ozone used in substitution or in combination with orthodox remedies.