Intradiscal O2O3: Rationale, Injection Technique, Short- and Long-term Outcomes for the Treatment of Low Back Pain Due to Disc Herniation

• Published in: Canadian Association of Radiologists journal 2017-05, Vol.68 (2), p.171-177
• Main Authors: Giurazza, Francesco, Guarnieri, Gianluigi, Murphy, Kieran J., Muto, Mario
• Format: Article
• Language: English
• Subjects: Herniation; Intradiscal; Long-term outcomes; Low back pain; Ozone
• ISSN: 0846-5371; 1488-2361
• DOI: 10.1016/j.carj.2016.12.007

The management of low back pain should always start with a conservative approach; however, when it fails, intervention is required and at that moment the most appropriate choice remains unclear. Before invasive surgery, minimally invasive techniques can be adopted. In European trials and in a trans-Canadian clinical trial 03 ozone has been used successfully. In total over 50,000 patients have been treated safely. Ozone is a gas normally present in the atmosphere with potent oxidizing power; it has been used for percutaneous intradiscal injection combined with oxygen (O2O3) at very low concentrations for 15 years in Europe. The main indication is back pain with or without radicular pain but without motor deficits, which is refractory to 4-6 weeks of conservative therapies. Its mechanism of action on the disc is mechanical (volume reduction by subtle dehydration of the nucleus pulposis) and antinflammatory. The intradiscal ozone injection is performed with a thin needle (18-22 gauge) image guided by computed tomography or angiofluoroscopy and is usually complimented by periganglionic injection of corticosteroids and anesthetics. This combination gives immediate pain relief and allows time for the ozone to act. It is a cost-effective procedure that presents a very low complication rate (0.1%). The radicular pain is resolved before the back pain does, as is seen with microdiscectomy. Peer-reviewed publications of large randomized trials, case series, and meta analysis from large samples of patients have demonstrated the procedure to be safe and effective in the short and the long terms, with benefits recognized up to 10 years after treatment. We aim to review the principles of action of O2O3 and report the injection techniques, complications, and short- and long-term outcomes. Dans un premier temps, la prise en charge d'une lombalgie devrait toujours être axée sur un traitement conservateur. Si le traitement échoue, une intervention doit alors être envisagée. À cette étape, le choix de l'intervention n'est pas toujours évident. On peut faire l'essai de techniques peu effractives avant de procéder à une intervention chirurgicale effractive. Le recours à l'ozone 03 s'est avéré concluant dans le cadre d'essais européens et d'un essai clinique transcanadien. Au total, plus de 50 000 patients ont été traités en toute sécurité. L'ozone est un gaz naturellement présent dans l'atmosphère terrestre. Il a un pouvoir oxydant puissant. Des mélanges d'ozone et d'oxygène (O