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Soham Mukherjee

  


OZONE NUCLEOLYSIS: AN ALTERNATIVE TO ORTHOPAEDIC SURGERY *

  


Аннотация:
Back pain associated with herniated disks has become an important and increasingly general health problem, both in India and across the world. After all methods ofconservative treatment have been exhausted, nucleolysis may be a minimally invasive alternative to surgery. In nucleolysis, chondrolytic substances, or other substances which reduce the pressure within the disk by other means, are injected into the nucleus pulposus under CT scan or fluroscopic guidance. Among various substances, which have been employed for nucleolysis, an ozone-oxygen mixture appears to be very promising. The water-binding capacity of ozone results in a reduction of pain. Moreover, it has an anti-inflammatory effect and results in an increase in perfusion to the affected area. Ozone is converted into pure oxygen in the body and has a low allergic potential. Recent minimally invasivetherapeutic methods such as percutaneous nucleotomy or laser treatment have not been shown to be superior when compared with ozone nucleolysis   

Ключевые слова:
Slip disc, ozon, pain management   


Introduction. Low back pain (LBP) is one of the most common and important clinical, social, economic and public health problems affecting the human population worldwide.1 Around 70% of adults suffer from LBP at some point in their lifetime with various degrees of symptom severity.Additionally, 1.6% to 43% of these patients have LBP associated with sciatic symptoms.2 In the United States,the incidence of chronic low back pain ranges from 15% to 45%, with a prevalence of 30%.1 Most back pain has no recognizable cause on imaging studies and is usually attributed to muscle strain or ligament injuries (65%-70%). In 5% to 15% of cases, the source of LBP is related to degenerative joints and disc disease.2 The natural history of disk herniation is favorable; improvement of symptoms is the norm, and most episodes resolve spontaneously or after conservative therapy. However, studies have shown that low back pain is sometimes still present after long periods of time (at least 12 months) in 37% to 54% of patients.1,3 We know from the natural history of herniated disc that clinical symptoms tend to disappear in up to 50% of patients and the disc herniation can shrink at CT or MR scans within eight to nine months after the onset of back pain, but not all patients can wait so long before improvement symptoms.4,5 Studies dated as early as 1934 drew attention to the role of herniated nucleus pulposus as an important cause of low back pain and leg pain.6 Apart from conservative therapy, all other forms of treatmentaim at decompressing the nerve roots, which are the cause of the patient’s discomfort. These can be done by taking the disc out by surgery or by decompressing the foramen and disc by different interventions. Outcome studies of lumbar disc surgeries document a over all success rate between 49% to 95%.7 Short term success rate after surgery for lumbosacral disc herniation is around 95- 98% with a 2-6% incidence of true recurrence of herniation.This percentage decreases to around 80% in the long-term due to the onset of symptoms linked to Failed Back Surgery Syndrome (FBSS) characterised by recurrence and/ or hypertrophic scarring with severe symptoms in20% of patients.8,9 These figures have stimulated research into newer minimallyinvasive techniques to improve clinical results. At the same time, advances in percutaneous techniques by interventional procedures (chemonucleolysis with chemopapain, nucleodisckectomy introduced by Onik, IDET, LASER discectomy and nucleoplasty) have minimized the invasive nature of surgical techniques and avoid or decrease complications such as postsurgical infection. Reducing intervertebral disc size by mechanical aspiration of disc fragments or partially dissolving the herniation by drying reduces the conic pressure on the torn annulus and creates the space necessary for retropulsion whenever the circular fibres of the annulus regain a minimum capacity tocontain the disc under tension. All percutaneousprocedures are mildly invasive entailing only a shorthospital stay. By avoiding the spinal canal, these techniques also eliminate the risks of post-operativescarring linked to surgery which is often responsible for recurrence of pain.9-11 Besides oral pharmacological and rehabilitation treatments, ozone therapy has emerged as an alternative or additional treatment option for these patients. Ozone nucleolysis or ozone discectomy is anonsurgical intervention to treat disc herniation/disc prolapse & discogenic pain. This procedure has been proved via many studies and researches to be very safe and associated with high sucess rate for improving the physiological condition as well as pain sensations. The success rates reported in different studies vary from 65 to 80%. Epidural steroid injections under CT  orfluoroscopic guidance are also used to minimize radicular pain and to try to obtain complete pain relief. 12-14 Despite its widespread use to treat a variety of conditions, ozone therapy remains unknown to most physicians.Ozone (O3) is an allotropic form of oxygen, primarily known for its ecological properties, industrial applicationand therapeutic effects. Questions persist concerning its potential toxicity as an oxidant agent versus its reported clinical efficacy. Percutaneous techniques minimize the invasive nature of surgery, rendering administration more straightforward and faster while sparing healthy tissue and avoiding or minimizing complications such as postsurgical infection.15 Traditional open back Surgery for slip discIn traditional open back surgery, a five to six inches incision may be needed in order to see the affected nerve root. In creating such a sizeable incision, a large area of muscle also has to be cut to make an opening of three to five centimeters, leading to risks of substantial blood loss. Complications of back surgery also include the use of general anesthesia, which, depending on age and overall health, could be a significant risk factor. In addition to the invasiveness of the surgery, length of the stay in the hospital, the painful weeks/months of recuperation time, the heavy use of pain medications afterwards and the time a patient has to spend away from work should also be considered. Another important complication after back surgery is the likelihood of scar tissue formation.9- 12 In many cases, the amount of back surgery scar tissue formation leads to additional spine conditions, which could eventually lead the patient to need another surgical procedure. Unfortunately, there is 60% success rate of full recovery of symptoms with open back surgery. This poor success rate appears to be due to complications from back surgery. Scar tissue formation caused by back surgery can be extremely painful, limit mobility and flexibility, and greatly diminish quality of life. Extensive scar tissuebuild-up is typically associated with the long incisions and other tissue damage experienced during traditionalopenback surgery. While scar tissue itself is typically not painful, excessive formation of scar tissue can trigger painif it binds to or impinges on nerve roots.13,14 Patients with failed back surgery often live in significant pain and disability. This is a loop in which patients are caught. good pain relief brings the illusion of improved physical ability. But for many patients with failed back surgery, after a brief honeymoon period, pain, spasm, and weakness reappear at a low activity level. Although the nerve roots were not damaged directly by the failed back surgeries, the nerves are now encased in a web of scar tissue, which causes pain and spasm every time there are movements of the spine and legs.15

  


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Номер журнала Вестник науки №8 (17) том 2

  


Ссылка для цитирования:

Soham Mukherjee OZONE NUCLEOLYSIS: AN ALTERNATIVE TO ORTHOPAEDIC SURGERY // Вестник науки №8 (17) том 2. С. 52 - 58. 2019 г. ISSN 2712-8849 // Электронный ресурс: https://www.вестник-науки.рф/article/1998 (дата обращения: 12.07.2024 г.)


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