Clinical and imaging selection criteria treating lumbar disc herniations by oxygen-ozone therapy, corticosteroid and local anaesthetic.

Radicular lumbar back pain is an important public health problem not already provided with a unequivocal treatment approach. Medical and physical therapies represent the first solution, however when these are not successful, the second therapeutic step is still controversial and mini-invasive treatment may play an important role. In these cases oxygen-ozone therapy has been proved to be a very safe and effective option that is widely used with different modalities. This paper, by reviewing oxygen-ozone therapy literature data, aims to propose an effective procedural technique and to clarify patient’s selection criteria; furthermore complications and follow-up management are also considered.

The ozone: a therapeutic mediator in MODIC processes.

MODIC changes of signal in lumbar MRI offered a new vision of the spine degenerations process. Several theories try to explain this phenomenom. After a critical apraisal and based on our own experience, we propose ozone intradiscal injection as an effective and safe treatment for disc degeneration disease.

Use of medical ozone in fail back surgery syndrome: a systematic review.

The safety and efficacy of ozone injections in the spine for lumbar disc herniation has been proved in two systematic reviews with one metaanalysis. Many other papers with lower evidence level were published before encouraging its use for this pathology and other degenerative spinal diseases. Fail back surgery syndrome (FBSS) is a terrible situation with no clear treatment option presently. Some authors have dared to use ozone injections in these patients, based on its antiinflammatory action and its highly save portfolio. Due to the great disability and dramatic situation of FBSS patients, a systematic review is mandatory in order to clarify the potential role of ozone in this pathology.

The role and the effects of the ozone paravertebral injections, in lumbar disc herniation patients.

The results obtained from a group of patients suffering from discoradicular conflict syndrome treated with paravertebral oxygen-ozone injections were analyzed. From a total number of 8500 patients treated with ozone during the period 2002/2015, 880 patients underwent intradiscal injection and 7620 patients were treated with paravertebral ozone injections. This paper analyses a subgroup of 1850 patients (24.28% of the patients who were treated with paravertebral injections), including those patients who underwent the total 10-session treatment, complied with a 5-year follow-up and with the sample homogeneity parameters following a predictability therapeutic effectiveness (PET) index devised for such purpose (PET index O3) by us in 2009. The outcomes were assessed based on the VAS score and modified Mac Nab criteria. Definite results determined positive post-treatment outcomes considered excellent and good in 81% of the cases. Such effectiveness percentage resulted lower than the one achieved with the intradiscal injection technique (89%), and higher than the percentage seen in papers on the selective nerve root block technique.

The diamod tip.

This issue 5 is devoted to spine diseases that can be treated or improved by using medical ozone. Dr. Alberto Alexandre compiled during 2015 and 2016 a number of papers from experienced authors in order to prepare a monographic issue but found a lot of difficulty in publishing it. I offered him our Journal to publish these scientific works and he agreed. COVID-19 pandemic has produce a huge increase in publishing time for all journals but we finally have been able to produce this issue. Due to the delay in its publication, some papers have been published by their authors in other journals. We are hardly working in issue 6 that will be opened for different topics and we are preparing issue 7 that we expect to be a monographic on dental applications. All papers are welcomed!

Ozone as integrative and complementary support for pharmacological therapy.

Ozone is not nowadays used in a single medical branch, due to its immune and metabolic effects. This molecule is considered as a pro-drug which can induce at certain non-toxic doses a rearrangement of the biochemical pathways with the activation of a second messenger in a cascade with a multiple system action. Nonetheless, its difference from a drug consists in the fact that its action can’t be explained as a simple interaction between a molecule and a receptor, thus, it can’t be considered according to the classical pharmacological schemes and new concepts must be defined. Furthermore, ozone is able to activate Nfr2 protein. Our study reflects how the levels of Nrf2 in peripheral blood mononuclear cells were found to increase immediately after ozone exposure and when measured 30 minutes following reinfusion demonstrating that the oxidative stress was able to activate all the blood components. After a series of 3 systemic indirect endovenous applications, Nrf2 returned back to the basal level. At the end of the experiment the activities of superoxide dismutase and catalase were increased. This metabolic pathway is common to all cell lines. In light of the above, ozone could be very helpful as integrative and complementary support for pharmacological therapy modulating the oxidative stress component in many illnesses, elderly and rare diseases, according to not only a legal regulation but also a proper education and training of physicians.

Ozone therapy as complementary treatment for surgical infection: case report.

Background: Infection is a serious surgical complication that increases significantly morbidity and mortality rates as well as health care expenses. Bacterial ever-growing resistance to antibiotics makes the treatment of such events even more troublesome. Objective: Report on a surgical infection case treated with ozone as a complementary therapy. Methods and Materials: Female, 65 years old, submitted to a complex surgical procedure for adult kyphotic deformity correction that presented with early post-surgical infection. The patient was treated with revision surgery and antibiotics that improved the condition but were unable to delete the infection. Ozone, in its gaseous form, was injected subcutaneously and paravertebraly twice weekly for three weeks. Results: After 3 weeks of treatment the wound healed completely and repeated visits and blood exams up to one year after the surgery did not show recurrence of infection. Conclusions: Although not a definite indication on validity of ozone therapy for surgical infections, the results of this case report indicate a new way that merits to be explored.

“Not just herniated disc” back pain: Outcome of oxygen-ozone treatment in selected applications.

Low back pain and sciatica are highly debilitating conditions affecting all socioeconomic groups at an increasingly early age. They are caused by different often concomitant spinal disorders: disc or facet joint disease, spondylolisthesis (with or without listhesis), vertebral body and interapophyseal arthrosis, spinal stenosis, radicular and synovial cysts and, more rarely, infections and primary or metastatic cancer.Treatment of low back pain and/or sciatica requires an accurate diagnosis based on thorough history-taking and physical examination followed by appropriate imaging tests, namely computed tomography and/or magnetic resonance scans in addition to standard X-rays of the spine.In recent years, several reports have demonstrated the utility of oxygen-ozone therapy in reducing the size of herniated discs. The present study reports on the outcome of oxygen-ozone treatment in 416 patients with non-discogenic low back pain caused by degenerative disease of the posterior vertebral compartment (facet synovitis, Baastrup syndrome, spondylolysis and spondylolisthesis, facet degeneration).

Treatment of Degenerative Disc Disease associated with Modic changes, with ozone therapy. A new therapeutic proposal.

Introduction. Modic Changes (MCs) represent signal changes in the vertebral endplate and subchondral bone region visualized on T1 and T2 weighted magnetic resonance images (MRI). Three types of MCs It have been identified (Types 1 to 3). Modic changes are commonly associated with low-back pain (LBP). In the last few years scientific papers have shown that one of the causes of MCs (fundamentally, the MCs type 1) is the infection caused by an anaerobic bacterium of very low virulence: Propionibacterium acnes (P. acnes). This bacterium resides on the human skin, oral cavity, intestinal tract, and external ear canal as normal flora. As a consequence of tooth brushing and endodontic-therapy, could invade the blood stream leading to transient bacteremia. The authors propose a treatment which consists of Amoxicillin-clavulanate (500 mg/125 mg) three times a day, at 8-hour intervals, for 90 days/100 days. Objectives. Ozone therapy could be the gold standard therapy for MC1 because ozone is a powerful anti-microbial, anti-inflammatory and analgesic agent, which regulates oxidative stress, immune system and oxygen metabolism. Materials and Methods Patients with LBP lasting 6 months or more and MC1 confirmed by MRI of lumbar spine L3/L4 or L4/L5 or L5/S1 and who responded with 5 or more points on the VAS scale were treated with three intradiscal sessions of ozone therapy and ten paravertebral sessions. Results. Patients who were treated with ozone therapy according to our treatment proposal showed a substantial improvement on VAS comparing the beginning and the end of the treatment. They show a significant difference in pain, and general condition. However, these results were not reflected on ODI scale, neither on the MRI but we could notice certain improvements.

Ozone therapy in ethidium bromide-induced demyelination in rats: possible protective effect [abstract]

BACKGROUND: Multiple sclerosis is an autoimmune inflammatory disease of the central nervous system and it is characterized by excessive demyelination PURPOSE: The study aim to investigate the possible protective effect of ozone (O3) in ethidium bromide (EB) induced demyelination in rats either alone or in combination with corticosteroid in order to decreases the dose of steroid therapy. MATERIAL and METHODS: Rats were divided into 7 groups Group (1) normal control rats received saline. Group (2) sham-operated rats received saline. Group (3) sham operated rats received oxygen. Group (4) EB-treated rats received EB. Group (5) EB treated rats received oxygen. Group (6) EB treated rats received methyl prednisolone (MP) Group (7) EB treated rats received half the dose of MP concomitant with ozone. RESULTS: Significant improvement in the brain serotonin, dopamine, noradrenalin. A reduction of MDA,TNF-COX2 immune-reactivity was noticed in MP and oxygen groups . Furthermore, best amelioration was achieved by combining half the dose of methyl-prednisolone with ozone. CONCLUSION: We concluded that ozone has a protective effect on demyelination and can be used due to its protective effect in demyelinating diseases such as multiple sclerosis.