Ozone nucleolysis or ozone discectomy is a non-operative intervention slipped disc / disc prolapse & discogenic pain.
Muto suggested intradiscal injection of ozone for disc hernia in 1998 under CT guidance. Leonardi popularized fluoroscopy guided ozone injection into the intervertebral disc. After that, successful outcome has been reported from various European centers. It is very important to note from those reports that complications are remarkably few. Not a single serious life-threatening complication was found even after 300000 cases of Ozone nucleolysis, which stresses the safety of these procedures
How ozone acts? The action of ozone is due to the active oxygen atom liberated from breaking down of ozone molecule. When ozone is injected into the disc the active oxygen atom called the singlet oxygen or the free radicle attaches with the proteo-glycan bridges in the jelly-like material or nuceus pulposus. They are broken down and they no longer capable of holding water. As a result disc shrinks and mummified. So the intradiscal volume and intradiscal pressure is reduced. Thus there is decompression of nerve. It is almost equivalent to surgical discectomy and so the procedure is called ozone discectomy. It is also called ozone nucleolysis or ozonucleolysis. Besides, it has an anti-inflammatory action due to inhibitions of formation of inflammation producing substances and tissue oxygenation is increased due to increased 2,3 diphosphoglycerate level in the red blood cells. All these factors lead to decompression of nerve roots, decreased inflammation of nerve roots, and increased oxygenation to the diseased tissue for repair work.
It is done usually under local anaesthesia. Light general anaesthesia may be administered in apprehensive patients only. The patient is taken to the operation theater lying on prone position. Very fine needle is introduced into the diseased disc under fluoroscopic guidance. The position of needle tip may be confirmed by injecting some small amount of radio-opaque dye. Then some 3-5 cc of oxygen-ozone mixture (at a concentration of 29 microgram/ml.) is injected into the disc. Ozone at this concentration is not all harmful for the surrounded tissue. So if ozone spreads to the surrounded tissues including spinal cord causes no harm. Ozone molecule is not stable. It has a half-life of about 20 minutes only. So, within 20 minutes only half of the original ozone remains, the rest becomes oxygen. Increase in temperature decreases its half-life. For injection it is always freshly prepared on site (from an ozone generator) for immediate administration. Only Ozone resistant syringes can be used for injecting it. While needle with the syringe is taken out some amount of oxygen-ozone mixture is also injected into the paraspinal muscle and para-radicular soft tissue to reduce nerve root inflammation and increased oxygenation of the para-spinal muscles. Some 15 to 30 minutes is required to perform the total procedure depending on the experience of the interventionist.
There are few conditions when this procedure should not be performed. They are active bleeding from any site, pregnancy, G6PD deficiency, active hyperthyroidism, loss of control of urination & defecation, and progressive sensory & motor loss (paralysis).
Ozonucleolysis, ozone nucleolysis or ozone discectomy has a success rate of about 80%. On the other hand surgical discectomy has similar success rate but much higher side effects compared to remarkably few side effects of ozone discectomy. Ozone discectomy is usually a day care procedure and general anaesthesia is not usually required. Total cost of the procedure is much less than that of surgical discectomy. All these facts have made this procedure very popular European countries. It is also gaining popularity in India too due to low cost, less hospital stay, no post-operative discomfort and morbidity and very few side effects.
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