Massimiliano Natrella MD, Abstract Co-Author: Nothing to Disclose

Gianluca Fanelli MD, Abstract Co-Author: Nothing to Disclose

Luca Duc MD, Abstract Co-Author: Nothing to Disclose

Dany Furfaro MD, Presenter: Nothing to Disclose

Massimo Cristoferi MD, Abstract Co-Author: Nothing to Disclose

Teodoro Meloni MD, MD,PhD, Abstract Co-Author: Nothing to Disclose

Based on the experience gained from interventions performed in our department we wish to emphasize the effectiveness of intradiscal chemonucleolysis with injection of O2-O3 for the treatment of symptomatic intervertebral disc herniations. O2-O3 gas mixture has anti-inflammatory effects, it improve oxygenation and it leads to a dehydration and shrinkage of the disc. The rationale for O2-O3 therapy is that the patient’s pain is caused by mechanical compression of the nerve root associated with periganglionic and periradicular inflammatory responses.

From 2007 to 2011 we performed chemonucleolysis procedures with intradiscal injection of O2-O3 on 315 patients with symptomatic vertebral disc prolapse. The infiltration was performed under fluoroscopy guidance in the cervical, dorsal and lumbar discs. After interventions patients were contacted in a range time between 2 months and 3 years and tehy were subjected to a questionnaire to evaluate the outcome. The "modified McNab method" and the NRS (Numerical Rating Scale) were used for the evaluation.  

The results were very satisfactory as the majority of patients has been successfully treated. Instead a few patients had no improvement and only a minimum number of them reported a worsening of pain. However no one of our patients showed side effects related to the procedure. It must also be noted that best results (McNab 1) were obtained in patients: who were not already suffering from very important disc disease, who belonged to a younger age and who carried out and maintained a good supply of recovery after surgery (like specific gimnastic). Instead the few cases of failure (McNab 4) were mainly patients who already had a significant disc disease and who belonged to an age in wich it is easy to have concomitant factors that could cause or increase pain (arthrosis, accidents, heavy work).  

The intradiscal chemonucleolysis is a minimally invasive technique that allows an effective pain control in patients with disc herniation, especially in the population belonging to a particular age group. However, as we can also find in the literature, this technique neither penalizes nor precludes the possibility to perform afterwards  the more invasive surgery.

Chemonucleolysis performed under fluoroscopy guidance allows to easily achieve excellent results with low risk.  

Natrella, M, Fanelli, G, Duc, L, Furfaro, D, Cristoferi, M, Meloni, T, Chemonucleolysis in Disk Herniation: Our Experience  in  O2-O3 Treatment and Review of the Literature.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11003531.html