Spinal Pain

It is one of the commonest experiences of humankind.

Point prevalence is approximately 50%.

It is probably experienced by nearly everyone at some point in his or her life.

Spinal Pain

In 90% cases it resolves spontaneously within 4 weeks regardless of treatment,

or even without any treatment.or even without any treatment.

Red Flags Possible fracture Possible tumor or infection. Bladder or Bowel dysfunction. Severe or progressive neurologic

dysfunction in the legs. Major motor weakness in quadriceps,

plantar flexors, evertors, and dorsiflexors.

Spinal Pain The remaining 10% of adults represents

one of the greatest challenges to conventional medical treatment.

Approx 5-6% of total sufferers needs more invasive therapeutic modalities, ending in one or more surgeries to obtain pain relief.

Spinal Pain

Prolapsed IV Disc:History Since it was first diagnosed by Dandy & then by

Mixter and Barr over 70 years ago it has been implicated as major cause of low back & neck

pain, which are not responding to the conservative therapy.

PID:Treatment options Decompression of nerves

These can be done by taking the disc out and decompressing the Nerves by surgery.

Decompression by different interventions.

Different Interventions Epidural Steroid Inj. Epidurogram & Epidurolysis. Nerve root sleeve/ transforaminal Inj. Intra-discal steroid inj. Nucleoplasty Chemo-nucleolysis with Chymopapain Ozone Discolysis

The various treatment options has confused clinicians and investigators due

to high failure rate and complications associated with different kinds of

surgeries and interventions.

PID:Treatment options

Failure rates

Different types of surgeries: 10 to 51%

Ozone Discolysis: 10 to 21%

Ozone Discolysis

A safer alternative to Chemonucleolysis, other interventions and disc surgery.

It has high success rate (nearly 90%). It is less invasive. Fewer chances of recurrences. Remarkably fewer side effects.

It’s action is due to the active oxygen atom (singlet oxygen) liberated from it.

It attaches with the proteo-glycan bridges in the nucleus pulposus.

They are broken down and they no longer capable of holding water.

As a result disc shrinks and mummified and there is decompression of nerve roots.

Ozone Discolysis: How it acts?

Must have H/O failed conservative treatment for more than 4 weeks.

Must have positive CT/MRI scan. Do not have red flag signals

Ozone Discolysis: selection criteria

Ozone Discolysis: the procedure

Percutaneous injection of ozone-oxygen mixture.

Conc. Of ozone is 29-30 microgram /ml. Ozone gas is injected immediately from

an ozone generator. 3-4 ml of ozone is injected at the centre

of the disc with/without intraforaminal injection.

Procedure is performed under CT or C-Arm guidance.

Ozone Nucleolysis: safety profiles

Not a single serious life-threatening complications was found in over

1,20,000 cases of Ozone Discolysis in different centers of European countries.

Ozone Discolysis: safety profiles

In a multi-centre, retrospective 3 year follow-up study of lumber disc herniation treated with European Neurosurgical Institute protocol of ozone therapy in 917 patients showed 78.9% good & excellent results with only one case of disc infection which healed with antibiotic.

Our experiences

224 cases of Ozone Discolysis has been done with 3 months follow up.

196 cases had good to excellent results in 3 months follow up.

12 patients did not respond. 16 patients responded but pain came

back between 2- 8 weeks. No major complications in any patients. So 87.5% had good to excellent results.

Comparison: Spinal Surgery Ozone Discolysis

1. More Hospital Stay.2. Complications of

prolonged surgery & anaesthesia.

3. Chance of “failed back surgery syndrome”

4. Costly 5. Failure rate 10-51%6. Safety profile compared

to Ozone Discolysis is not so high.

7. Repeat surgeries are more complicated.

1. One day/Day Care.2. GA is not required.

3. No chances of “failed back surgery syndrome”

4. Cost is 1/5th to 1/10th

5. Comparable 10-21%6. Very high safety profile.

7. May be repeated many times without significant complications.

Other uses in Pain Management Ozone used as tissue proliferant in a

conc. of 5-10micgr./ml. Used in Osteo-arthritis of knee. Ozone has a strong anti-inflammatory

property and used as trigger point inj. In Fibromyalgia & Myofascial Pain.

Used in Rheumatoid Arthritis.

summary Spinal Pain is a very common

sufferings, most of which resolves spontaneously with/without any treatment.

Those who are not improved by 4 weeks are a challenge to the medical community.

Many of these suffers from PID

summary There are diff. Surgeries & diff.

Interventions to treat PID Ozone Discolysis is a Percutaneous

procedure almost devoid of serious complications but a high success rate of nearly 90%, with a low recurrence rate, less hospital stay & much economical compared to surgeries.

Thank youThank you