Abstract

Aim: To objectively evaluate the effect of single percutaneous trans-foraminal ozone injection on the lumbar disc inducing morphological change on Magnetic Resonance Imaging (MRI) of the Lumbar disc and relate to the clinical improvement in patients with contained acute lumbar disc herniation.

Material & Methods: 30 young patients with acute contained lumbar disc herniation with adequate hydration were treated with single percutaneous injection of ozone via transforaminal route under fluoroscopic guidance.  All patients were managed conservatively and followed in Outpatient department for 1 yr with repetition of MRI AT 4 weeks, 6 month and one year from the date of injection. Modified Macnab method was used for assessing clinical outcomes and compared with the changes in serial MRI imaging of every patient.

Results: Successful puncture was obtained in all patients confirmed by fluoroscopy. The MRI imaging in TW1 TW2 and STIR sequences were evaluated by radiologist who was blinded to the procedure. The results revealed no observable change in the MRI picture of the targeted lumbar discs attributable in all the three consecutive imaging studies covering a period of 1 year. The clinical outcome showed excellent response in 5cases, good in 5 cases and poor response in 20 cases according to the Macnab criteria at 4 weeks and by 1 year 20 patients had good outcome while 10 cases remained poor. No complications were found throughout this study.

Conclusion: A solitary percutaneous intra discal ozone injection via transforaminal route is safe. No discernible morphological change on serial conventional MRI sequences could be found. Lack of Proof of physical change in the lumbar disc by single injection of ozone questions the role of ozone. The improvement of clinical response is not found to be significant.

Keywords: Contained Lumbar disc prolapse, trans foraminal injection, Ozone therapy.

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