Martha Kerr

November 27, 2011

Chicago, Illinois (November 27, 2011) — Combined intradiscal and periganglionic injection of medical ozone plus a periganglionic injection of steroids addresses both the mechanical and the inflammatory components of pain caused by lumbar disk herniation. This approach might be an effective bridge between failed conservative management and surgery, researchers announced here at the Radiological Society of North America 97th Scientific Assembly and Annual Meeting.

Thomas Lehnert, MD, from the University of Frankfurt, Germany, and colleagues evaluated the therapeutic benefit and morphologic changes in herniated lumbar disks after a computed tomography (CT)-guided injection of intradiscal and periganglionic medical ozone combined with a periganglionic administration of steroids and an anesthetic in 327 patients with lumbar radiculopathy.

Patients received an intradiscal (3 mL) and periganglionic (7 mL) injection of an ozone–oxygen mixture (in a 3:97 ratio), followed by a periganglionic injection of 1 mL of betamethasone 17α-valerate (Celestan depot) and 2 mL of bupivacaine (Carbostesin 0.25%) in the same session.

Under CT guidance, intradiscal and periganglionic injection was administered using an extraspinal lateral approach, with a 22-gauge 17.8 cm spinal needle. Injections were delivered under CT guidance.

Dr. Lehnert's team reports success with this approach in 231 patients (70.6%). Outcome was excellent in 119 patients (51.5%) and good in 112 patients (48.5%).

Among the 96 (29.4%) patients whose treatment was defined as a failure, outcome was poor in 73 patients (76.0%) and poor with recourse to surgery in 23 patients (24.0%). Complications occurred in 32 patients, who presented with episodes of impaired sensitivity in the lower limb ipsilateral to the treatment; the episodes resolved spontaneously within 2 hours.

Initial disk volume was 8.12 to 29.27 cm³ (mean, 18.41 cm³). Six months after treatment, disk volume reduction was 5.44% to 22.31% (mean, 14.31%) in patients with excellent outcome. In those with a good outcome, disk volume reduction was 3.11% to 17.01% (mean, 8.64%). In patients with a poor outcome, there was still a reduction in disk volume, but it was much less significant, at 0.29% to 8.96% (mean, 4.61%).

"Our study shows that the combined intradiscal and periganglionic injection of medical ozone and periganglionic injection of steroids affects both the mechanical and the inflammatory components of pain caused by disk herniation," the authors write in their abstract. "For this reason, this is a therapy option for treating lumbar disk herniation that has failed to respond to conservative management, before recourse to surgery or when surgery is not possible."

"The ease of execution and noninvasiveness of this therapy permit the successful outpatient treatment of lumbar sciatic pain," Dr. Lehnert's team says.

Disclosure information was not available at the time of publication.

Radiological Society of North America (RSNA) 97th Scientific Assembly and Annual Meeting: Abstract SSA13-01. Presented November 27, 2011.

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