Thomas Lehnert MD, Presenter: Nothing to Disclose

Suja Mundackatharappel, Abstract Co-Author: Nothing to Disclose

Christopher Herzog MD, Abstract Co-Author: Nothing to Disclose

Wolfram Schwarz MD, Abstract Co-Author: Nothing to Disclose

Martin G. Mack MD, Abstract Co-Author: Nothing to Disclose

Thomas Josef Vogl MD, Abstract Co-Author: Nothing to Disclose

To evaluate the therapeutic benefit and morphologic changes in herniated lumbar disk after CT-guided intradiscal and periganglionic ozone-oxygen injection combined with a periganglionic administration of steroids and anesthetic.

92 patients with lumbar radiculopathy received an intradiscal (3 mL) and periganglionic (7 mL) injection of an ozone-oxygen mixture (ratio 3:97), followed by a periganglionic injection of corticosteroid (1 mL of Celestan® Depot, ESSEX PHARMA, Munich, Germany) and anesthetic (2 mL of Carbostesin® 0.25%, AstraZeneca, Wedel, Germany) in the same session. Under CT guidance, intradiscal and periganglionic injection was administered by means of an extraspinal lateral approach, using a 22-gauge 17.8-cm spinal needle (Becton Dickinson & Co, Franklin Lakes, NJ). 6 months after treatment, clinical outcome was assessed by applying the modified MacNab method. Effects on disk matrix and disk volume were evaluated by MRI.

Treatment was successful in 73 patients (79.35%). In the remaining 19 patients (20.65%), treatment was considered to have failed. Among the patients whose treatment was a success, outcome was excellent in 46 patients (63.01%) and good in 27 (36.99%). Among the patients whose treatment was a failure, this was poor in 17 patients (89.47%) and poor with recourse to surgery in 2 patients (10.53%). Initial disk volume was 8.61-28.36 cm³ (mean, 16.45 cm³). 6 months after treatment, in patients with excellent outcome disk volume reduction was 6.04-19.34% (mean, 14.02%), in patients with good outcome 3.64-16.19% (mean, 8.34%) and in patients with poor outcome 0.81-6.39% (mean, 4.07%). In those 2 patients, who finally underwent surgery, disk volume increased to 1.67–3.03 % (mean, 2.35 %), 6 month after injection.

Our study shows that the combined intradiscal and periganglionic injection of medical ozone and periganglionic administration of steroids affects both the mechanical and the inflammatory components of pain caused by disk herniation.

This therapy offers a treament option for lumbar disk herniation that has failed to respond to conservative management, before recourse to surgery or when surgery is not possible.

Lehnert, T, Mundackatharappel, S, Herzog, C, Schwarz, W, Mack, M, Vogl, T, Combined Intradiscal and Periganglionic Injection of Medical Ozone and Periganglionic Administration of Steroids and Anesthetic for the Treatment of Lumbar Disk Herniation: Effects on Disk Size and Lumbar Radiculopathy.  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/4432619.html