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J Vasc Interv Radiol ; 27(8): 1242-1250.e3, 2016 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-27363296


PURPOSE: To elucidate the mechanism of action of intradiscal oxygen-ozone therapy for herniated intervertebral disc therapy. METHODS: Ozone's mechanism of action was investigated using 3 approaches: mathematical models of intervertebral disc space to explore the relationship between disc pressure and volume; ozonolysis experiments using glycosaminoglycans (GAGs) from a Chinese hamster ovary cell line that were similar in composition to GAGs found in human nucleus pulposus; and experiments in which live Yucatan miniature pigs received various concentrations of percutaneous, image-guided intradiscal oxygen-ozone treatment and were examined (after sacrifice) with histology and semiquantitative analysis of disc cytokine concentrations. RESULTS: Engineering calculations support observations that a small (6%) disc volume reduction can result in considerable (9.84%) intradiscal pressure reduction. Porcine disc histology and Chinese hamster ovary GAG ozonolysis results showed that administered ozone reacted with and fragmented disc proteoglycans, reducing disc volume through disc dehydration. Cytokine analysis of porcine discs found that each of 4 cytokines measured (interleukin [IL]-1ß, IL-6, IL-8, and tumor necrosis factor α) increased in concentration after 2 wt% ozone treatment. CONCLUSIONS: Oxygen-ozone therapy breaks down proteoglycan GAGs that maintain disc osmotic pressure, dehydrating the nucleus pulposus and reducing intervertebral disc volume. This is likely a primary mechanism by which ozone relieves nerve root compression and alleviates herniated disc-related pain. Additionally, 2 wt% ozone appears to interact with intradiscal cytokines, generating an antiinflammatory response that may contribute to symptom improvement.

Antiinflamatorios/administración & dosificación , Desplazamiento del Disco Intervertebral/tratamiento farmacológico , Disco Intervertebral/efectos de los fármacos , Vértebras Lumbares/efectos de los fármacos , Ozono/administración & dosificación , Animales , Células CHO , Simulación por Computador , Cricetulus , Citocinas/metabolismo , Modelos Animales de Enfermedad , Módulo de Elasticidad , Glicosaminoglicanos/metabolismo , Inyecciones Espinales , Disco Intervertebral/metabolismo , Disco Intervertebral/patología , Disco Intervertebral/fisiopatología , Desplazamiento del Disco Intervertebral/metabolismo , Desplazamiento del Disco Intervertebral/patología , Desplazamiento del Disco Intervertebral/fisiopatología , Vértebras Lumbares/metabolismo , Vértebras Lumbares/patología , Vértebras Lumbares/fisiopatología , Modelos Biológicos , Núcleo Pulposo/efectos de los fármacos , Núcleo Pulposo/metabolismo , Núcleo Pulposo/patología , Presión Osmótica , Porcinos , Porcinos Enanos
Can Assoc Radiol J ; 66(4): 377-84, 2015 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-26092159


PURPOSE: The primary objective of this pilot study was to compare pain and function scores from patients before and after an ozone injection in combination with steroids and bupivacaine to treat herniated discs. A secondary objective was to correct some of the methodological weaknesses of some previously published ozone studies. METHODS: Fifty patients were enrolled; 1-3 mL of 2 wt% ozone in 98 wt% oxygen was delivered into the nucleus pulposus, and 7-9 mL into the adjacent paravertebral tissues. The oxygen/ozone treatment was followed by a periganglionic injection of corticosteroid and bupivacaine. All patients were evaluated 1 month after the treatment to quantify improvement in pain and function, and to monitor for potential adverse events. RESULTS: Forty-four patients had intradiscal injections and were included in the analysis. After 1 treatment, 75.0% showed significant improvement in pain based on the visual analog scale (improvement >1.8), 72.7% showed significant improvement in function based on the Oswestry disability index (improvement >15%), and 79.5% showed improvement based on the modified MacNab criteria. There were no adverse events associated with the treatment. CONCLUSIONS: Patients showed significant improvement in pain and function after receiving ozone injections in combination with steroids and bupivacaine for the treatment of herniated discs. Because of the lack of a control group and short follow-up times, conclusions about the safety and efficacy of ozone injections for the treatment of herniated discs are not warranted. However, the results provide sufficient evidence that the risk and expense of an additional randomized controlled study is merited.

Bupivacaína/administración & dosificación , Desplazamiento del Disco Intervertebral/terapia , Vértebras Lumbares , Metilprednisolona/análogos & derivados , Ozono/administración & dosificación , Adolescente , Adulto , Anciano , Evaluación de la Discapacidad , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Disco Intervertebral/efectos de los fármacos , Vértebras Lumbares/efectos de los fármacos , Masculino , Metilprednisolona/administración & dosificación , Acetato de Metilprednisolona , Persona de Mediana Edad , Dimensión del Dolor , Proyectos Piloto , Estudios Prospectivos , Adulto Joven
J Vasc Interv Radiol ; 21(4): 534-48, 2010 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-20188591


PURPOSE: To determine statistically significant effects of oxygen/ozone treatment of herniated discs with respect to pain, function, and complication rate. MATERIALS AND METHODS: Random-effects metaanalyses were used to estimate outcomes for oxygen/ozone treatment of herniated discs. A literature search provided relevant studies that were weighted by a study quality score. Separate metaanalyses were performed for visual analog scale (VAS), Oswestry Disability Index (ODI), and modified MacNab outcome scales, as well as for complication rate. Institutional review board approval was not required for this retrospective analysis. RESULTS: Twelve studies were included in the metaanalyses. The inclusion/exclusion criteria, patient demographics, clinical trial rankings, treatment procedures, outcome measures, and complications are summarized. Metaanalyses were performed on the oxygen/ozone treatment results for almost 8,000 patients from multiple centers. The mean improvement was 3.9 for VAS and 25.7 for ODI. The likelihood of showing improvement on the modified MacNab scale was 79.7%. The means for the VAS and ODI outcomes are well above the minimum clinically important difference and the minimum (significant) detectable change. The likelihood of complications was 0.064%. CONCLUSIONS: Oxygen/ozone treatment of herniated discs is an effective and extremely safe procedure. The estimated improvement in pain and function is impressive in view of the broad inclusion criteria, which included patients ranging in age from 13 to 94 years with all types of disc herniations. Pain and function outcomes are similar to the outcomes for lumbar discs treated with surgical discectomy, but the complication rate is much lower (<0.1%) and the recovery time is significantly shorter.

Desplazamiento del Disco Intervertebral/tratamiento farmacológico , Desplazamiento del Disco Intervertebral/epidemiología , Dolor de la Región Lumbar/epidemiología , Dolor de la Región Lumbar/prevención & control , Ozono/uso terapéutico , Calidad de Vida , Comorbilidad , Humanos , Prevalencia , Medición de Riesgo , Factores de Riesgo