Thomas Lehnert MD, Presenter: Nothing to Disclose

Sebastian Lindemayr, Abstract Co-Author: Nothing to Disclose

Nagy N. N. Naguib MSc, Abstract Co-Author: Nothing to Disclose

Nour-Eldin Abdelrehim Nour-Eldin MSc,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.

283 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, USA). 6 months after treatment, clinical outcome was assessed by applying the modified MacNab method. The effects on disk matrix and disk volume were evaluated by MRI.

Treatment was successful in 202 patients (71.4%). In the remaining 81 patients (28.6%), treatment was considered to have failed. Among the patients whose treatment was a success, outcome was excellent in 108 patients (53.5%) and good in 94 patients (46.5%). Among the patients whose treatment was a failure, this was poor in 58 patients (71.6%) and poor with recourse to surgery in 23 patients (28.4%). Complications occurred in 27 patients (9.5%), who presented with episodes of impaired sensitivity in the lower limb ipsilateral to the treatment; the episode resolved spontaneously within 2 hours. Initial disk volume was 8.12-29.15 cm³ (mean, 18.37 cm³). 6 months after treatment, in patients with excellent outcome disk volume reduction was 5.61-22.31% (mean, 14.88%), in patients with good outcome 3.64-17.01% (mean, 8.71%) and in patients with poor outcome 0.29-8.02% (mean, 4.51%).

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. 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 non-invasiveness of this therapy permit the successful outpatient treatment of lumbar sciatic pain.

Lehnert, T, Lindemayr, S, Naguib, N, Nour-Eldin, N, Vogl, T, Final Results of 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 in 283 Patients.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9008370.html