Abstract

CANOVAS, L. et al. Sciatica: intradiscal ozone administration associated with pulsed radiofrequency of the dorsal root ganglia compared with the isolated use of each of these two techniques. Rev. Soc. Esp. Dolor [online]. 2009, vol.16, n.3, pp.141-146. ISSN 1134-8046.

Objective: We performed a prospective, comparative study that evaluated the effectiveness of intradiscal ozone administration associated with pulsed radiofrequency of the compromised lumbar root versus the isolated use of each of these two techniques in the management of radicular pain secondary to a herniated disc. Materials and method: The study included 30 patients with severe back pain, visual analog scale (VAS) > 6 and onset more than 3 months previously, who were resistant to conservative treatment (oral medication and epidural drugs) and showed signs of radicular involvement with or without paresthesia and hypoesthesia in the region of the affected dermatomes. The radiological inclusion criteria were magnetic resonance imaging (MRI) evidence of a contained herniated disc with or without disc degeneration. The patients were randomly distributed into three groups: group A (5-15 ml intradiscal ozone concentration at 27 mg/ml and pulsed radiofrequency of the compromised dorsal root ganglia); group B (5-15 ml of intradiscal ozone concentration at 27mg/ml) and group C (pulsed radiofrequency of the dorsal root ganglia at the level of the hernia). Analgesic efficacy was assessed at 15 days, 1 month, 3 months and 6 months of the technique, using the VAS. Radiological assessment with MRI was performed after 3 months. The statistical analysis was conducted using SPSS 14.0 for Windows. Values of P < 0.05 were considered significant. Results: the levels affected, in order of frequency, were L4-L5 (16/53.3%), L5-S1 (10/33.3%) and L3-L4 (4/13.33%). The mean amount of ozone administered was 8 ± 2.5 ml in group A and 6.5 ± 2.4 ml in group B. In group A, 90% of the patients showed significant improvement (p < 0.05) in all follow-up evaluations. In 80% of the patients in group B, improvement occurred later, but was maintained at 6 months after the technique. In group C, 90% of the patients showed improvement at an early stage, but its duration was significantly shorter than in the other two groups. MRI showed a significant reduction in hernia volume in groups A and B (65% and 70% respectively). No complications associated with the techniques were observed. Conclusions: Pulsed radiofrequency of the affected root improved the effectiveness of intradiscal ozone administration, with early onset of pain reduction, which was subsequently maintained by the late ozone-induced reduction in hernia size.

Keywords : Ozone; Radiofrequency; Discolysis; Radiculopathy; Herniated disc.

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