ozone in pain management
TRANSCRIPT
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Spinal Pain
It is one of the commonest experiences of humankind.
Point prevalence is approximately 50%.
It is probably experienced by nearly everyone at some point in his or her life.
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Spinal Pain
In 90% cases it resolves spontaneously within 4 weeks regardless of treatment,
or even without any treatment.or even without any treatment.
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Red Flags Possible fracture Possible tumor or infection. Bladder or Bowel dysfunction. Severe or progressive neurologic
dysfunction in the legs. Major motor weakness in quadriceps,
plantar flexors, evertors, and dorsiflexors.
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Spinal Pain The remaining 10% of adults represents
one of the greatest challenges to conventional medical treatment.
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Approx 5-6% of total sufferers needs more invasive therapeutic modalities, ending in one or more surgeries to obtain pain relief.
Spinal Pain
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Prolapsed IV Disc:History Since it was first diagnosed by Dandy & then by
Mixter and Barr over 70 years ago it has been implicated as major cause of low back & neck
pain, which are not responding to the conservative therapy.
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PID:Treatment options Decompression of nerves
These can be done by taking the disc out and decompressing the Nerves by surgery.
Decompression by different interventions.
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Different Interventions Epidural Steroid Inj. Epidurogram & Epidurolysis. Nerve root sleeve/ transforaminal Inj. Intra-discal steroid inj. Nucleoplasty Chemo-nucleolysis with Chymopapain Ozone Discolysis
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The various treatment options has confused clinicians and investigators due
to high failure rate and complications associated with different kinds of
surgeries and interventions.
PID:Treatment options
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Failure rates
Different types of surgeries: 10 to 51%
Ozone Discolysis: 10 to 21%
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Ozone Discolysis
A safer alternative to Chemonucleolysis, other interventions and disc surgery.
It has high success rate (nearly 90%). It is less invasive. Fewer chances of recurrences. Remarkably fewer side effects.
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It’s action is due to the active oxygen atom (singlet oxygen) liberated from it.
It attaches with the proteo-glycan bridges in the nucleus pulposus.
They are broken down and they no longer capable of holding water.
As a result disc shrinks and mummified and there is decompression of nerve roots.
Ozone Discolysis: How it acts?
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Must have H/O failed conservative treatment for more than 4 weeks.
Must have positive CT/MRI scan. Do not have red flag signals
Ozone Discolysis: selection criteria
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Ozone Discolysis: the procedure
Percutaneous injection of ozone-oxygen mixture.
Conc. Of ozone is 29-30 microgram /ml. Ozone gas is injected immediately from
an ozone generator. 3-4 ml of ozone is injected at the centre
of the disc with/without intraforaminal injection.
Procedure is performed under CT or C-Arm guidance.
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Ozone Nucleolysis: safety profiles
Not a single serious life-threatening complications was found in over
1,20,000 cases of Ozone Discolysis in different centers of European countries.
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Ozone Discolysis: safety profiles
In a multi-centre, retrospective 3 year follow-up study of lumber disc herniation treated with European Neurosurgical Institute protocol of ozone therapy in 917 patients showed 78.9% good & excellent results with only one case of disc infection which healed with antibiotic.
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Our experiences
224 cases of Ozone Discolysis has been done with 3 months follow up.
196 cases had good to excellent results in 3 months follow up.
12 patients did not respond. 16 patients responded but pain came
back between 2- 8 weeks. No major complications in any patients. So 87.5% had good to excellent results.
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Comparison: Spinal Surgery Ozone Discolysis
1. More Hospital Stay.2. Complications of
prolonged surgery & anaesthesia.
3. Chance of “failed back surgery syndrome”
4. Costly 5. Failure rate 10-51%6. Safety profile compared
to Ozone Discolysis is not so high.
7. Repeat surgeries are more complicated.
1. One day/Day Care.2. GA is not required.
3. No chances of “failed back surgery syndrome”
4. Cost is 1/5th to 1/10th
5. Comparable 10-21%6. Very high safety profile.
7. May be repeated many times without significant complications.
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Other uses in Pain Management Ozone used as tissue proliferant in a
conc. of 5-10micgr./ml. Used in Osteo-arthritis of knee. Ozone has a strong anti-inflammatory
property and used as trigger point inj. In Fibromyalgia & Myofascial Pain.
Used in Rheumatoid Arthritis.
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summary Spinal Pain is a very common
sufferings, most of which resolves spontaneously with/without any treatment.
Those who are not improved by 4 weeks are a challenge to the medical community.
Many of these suffers from PID
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summary There are diff. Surgeries & diff.
Interventions to treat PID Ozone Discolysis is a Percutaneous
procedure almost devoid of serious complications but a high success rate of nearly 90%, with a low recurrence rate, less hospital stay & much economical compared to surgeries.
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