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Órgano Oficial de difusión científica de la Asociación Mexicana de Cirujanos de Columna A. C.

2023, Number 3

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Cir Columna 2023; 1 (3)

Complications after infiltration by ozone therapy for the treatment of disc degeneration and lumbar radiculopathy

Martínez BJM, Robles ORE, Rodríguez MAF, Sánchez SJF, Cruz GMA, Ramírez SD, Francés SE, Sánchez JS

Language: Spanish
References: 20
Page: 180-186
PDF size: 280.95 Kb.


ABSTRACT

Ozone is a medical gas described since the 19th century; the ozone therapy has evolved to date in terms of its applications and its usefulness in various diseases due to its action at the molecular level and in dissimilar diseases associated with painful processes of inflammatory origin such as present in herniated discs of the spine, although the benefits of its application are currently in controversy, as well as the various complications that may occur after its application. Pneumocephalus is a complication that occurs in the background of a head injury or neurosurgery. Ozone infiltrations are used for the treatment of disc prolapse to reduce clinical symptoms. The anti-inflammatory effect of ozone is supported by its ability to oxidize compounds that contain double bonds such as arachidonic acid and prostaglandins, which are active substances with high concentrations in the inflammatory process. The appearance of pneumoencephalus and arachnoiditis chemical after epidural injection and also with ozone infiltrations is a rare complication but it has been described in recent years as a devastating post-application complication. Arachnoiditis can present as sensory and motor deficits, paresthesias, transient radicular neurological syndrome (TRNS), cauda equina syndrome, and conus medullaris. In relation to arachnoiditis, cases as severe as cauda equina syndrome after spinal anaesthesia, and more benign such as TSNR have been described, characterized by low back pain that radiates to the lower extremities, and not associated with motor deficits. neither sensitive, nor sphincter incontinence, which appears in the first 24 hours, which can last several days, and which resolves without neurological sequelae. Understanding the pathophysiology is important to assess and diagnose this type of neurological complications, especially in patients with disc disease who have undergone this type of treatment. The purpose of this report is to present the case of a patient with disc disease with the presence of radiculopathy who underwent infiltration by ozone therapy, who immediately presented complications such as pneumoencephalus and chemical arachnoiditis that led her to remain hospitalized in intensive care and present cauda equina syndrome.


REFERENCES

  1. Ahmad M, Bellamy S, Ott W, Mekhail R. Pneumocephalus secondary to epidural analgesia: a case report. J Med Case Rep. 2023; 17: 217. Available in: https://doi.org/10.1186/s13256-023-03955-5

  2. Andreini I, Arrigucci U, Monti L, Bellini M, Battisti C, Federico A. A case of pneumocephalus as complication of ozone therapy: diagnosis and treatment. Neurol Sci. 2020; 41: 481-483. Available in: https://doi.org/10.1007/s10072-019-04062-4

  3. Zhang Y, Ma Y, Jiang J, Ding T, Wang J. Treatment of the lumbar disc herniation with intradiscal and intraforaminal injection of oxygen-ozone. J Back Musculoskelet Rehabil. 2013; 26: 317-322. Available in: https://doi.org/10.3233/BMR-130386

  4. Simon C, Le Corroller T, Pauly V, Creze M, Champsaur P, Guenoun D. Intradiscal oxygen-ozone therapy for the treatment of symptomatic lumbar disc herniation: a preliminary study. J Neuroradiol. 2022; 49: 180-186. Available in: https://doi.org/10.1016/j.neurad.2021.09.004

  5. Haseeb AESA, Abd El Hares AEH, Abd El Moez KM, Mustafa AI, Ahmed OEA. Comparative study between treatment of lumbar disc herniation with intra discal ozone and transforaminal steroid injection versus steroid injection only. The Egyptian Journal of Hospital Medicine. 2019; 74: 705-720. Available in: https://doi.org/10.21608/EJHM.2019.24068

  6. Palumbo, P., Bruno, F., Arrigoni, F., Zappia, M., Ierardi, A. M., Guglielmi, et al. Diagnostic and interventional management of infective spine diseases. Acta Biomed. 2020; 91: 125-135. Available in: https://doi.org/10.23750/abm.v91i8-S.9994

  7. Salaffi F, Ceccarelli L, Carotti M, Di Carlo M, Polonara G, Facchini G, et al. Differentiation between infectious spondylodiscitis versus inflammatory or degenerative spinal changes: how can magnetic resonance imaging help the clinician? Radiol Med. 2021; 126: 843-859. Available in: https://doi.org/10.1007/s11547-021-01347-7

  8. Ercalik T, Kilic M. Efficacy of intradiscal ozone therapy with or without periforaminal steroid injection on lumbar disc herniation: a double-blinded controlled study. Pain Physician. 2020; 23: 477-484. PMID: 32967390.

  9. Buric J, Rigobello L, Hooper D. Five and ten year follow-up on intradiscal ozone injection for disc herniation. Int J Spine Surg. 2014; 8: 17. Available in: https://doi.org/10.14444/1017

  10. Ghatge SB, Shah RP, Surya N, Sankhala S, Unadkat CJ, Khan GM, et al. Ozone disc nucleolysis in cervical intervertebral disc herniation: A nonrandomized prospective analysis in 246 patients. J Craniovertebr Junction Spine. 2022; 13: 114-120. Available in: https://doi.org/10.4103/jcvjs.jcvjs_46_22

  11. Kelekis A, Bonaldi G, Cianfoni A, Filippiadis D, Scarone P, Bernucci C, et al. Intradiscal oxygen-ozone chemonucleolysis versus microdiscectomy for lumbar disc herniation radiculopathy: a non-inferiority randomized control trial. Spine J. 2022; 22: 895-909. Available in: https://doi.org/10.1016/j.spinee.2021.11.017

  12. Kilic M, Ercalik T, Ozdemir B, Yilmaz I, Oguzoglu AS, Aydin L, et al. Lumbar intradiscal ozone chemonucleolysis applied together with the epidural steroid treatment. Sisli Etfal Hastan Tip Bul. 2021; 55: 203-209. Available in: https://doi.org/10.14744/SEMB.2020.55649

  13. Fort NM, Aichmair A, Miller AO, Girardi FP. L5-S1 Achromobacter xylosoxidans infection secondary to oxygen-ozone therapy for the treatment of lumbosacral disc herniation: a case report and review of the literature. Spine (Phila Pa 1976). 2014; 39: E413-416. Available in: https://doi.org/10.1097/BRS.0000000000000195

  14. Ilhan B, Dogan H. Novel complication of ozone therapy: Massive emphysema and pneumomediastinum. Am J Emerg Med. 2021; 41: 190-192. Available in: https://doi.org/10.1016/j.ajem.2020.03.045

  15. Schar RT, Sutter M, Mannion AF, Eggspühler A, Jeszenszky D, Fekete TF, et al. Outcome of L5 radiculopathy after reduction and instrumented transforaminal lumbar interbody fusion of high-grade L5-S1 isthmic spondylolisthesis and the role of intraoperative neurophysiological monitoring. Eur Spine J. 2017; 26: 679-690. Available in: https://doi.org/10.1007/s00586-017-4964-3

  16. Rao SM, Kotgire L, Sastri BVS. Pneumocephalus caused by an epidural ozone injection for treatment of disc prolapse. Res Pract Anesthesiol Open J. 2019; 4: 11-13. Available in: https://doi.org/10.17140/RPAOJ-4-124

  17. Perri M, Grattacaso G, di Tunno V, Marsecano C, Gennarelli A, Michelini G, et al. T2 shine-through phenomena in diffusion-weighted MR imaging of lumbar discs after oxygen-ozone discolysis: a randomized, double-blind trial with steroid and O2-O3 discolysis versus steroid only. Radiol Med. 2015; 120: 941-950. Available in: https://doi.org/10.1007/s11547-015-0519-z

  18. Calle G, Huayhua L, Martinez A. The role and the effects of the ozone paravertebral injections, in lumbar disc herniation patients. J Ozone Ther. 2020; 4: 24-36. Available in: https://doi.org/10.7203/jo3t.4.5.2020.18023

  19. Toman H, Ozdemir U, Kiraz HA, Lüleci N. Severe headache following ozone therapy: pneumocephalus. Agri. 2017; 29: 132-136. Available in: https://doi.org/10.5505/agri.2016.36024

  20. Murphy K, Muto M, Steppan J, Meaders T, Boxley C. Treatment of contained herniated lumbar discs with ozone and corticosteroid: a pilot clinical study. Can Assoc Radiol J. 2015; 66: 377-384. Available in: https://doi.org/10.1016/j.carj.2015.01.003




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