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ECR 2013 / C-0541
MR imaging assessment of the lumbar disc herniation treated with oxygen-ozone(O2-O3) discolysis:  Role of DWI and related ADC versus intervertebral disc volumetric analysis for detecting response to treatment
Congress: ECR 2013
Poster No.: C-0541
Type: Scientific Exhibit
Keywords: Musculoskeletal spine, Neuroradiology peripheral nerve, Interventional non-vascular, CT, MR, Outcomes analysis, Observer performance, Puncture, Hernia, Outcomes, Image verification
Authors: M. Perri, L. Sacchetti, G. Grattacaso, L. M. Gregori, A. V. Giordano, M. Gallucci, C. Masciocchi; L'Aquila/IT
DOI:10.1594/ecr2013/C-0541

Conclusion

Intradiscal O2-O3 mixture injection produces a chemodiscolysis of nucleus pulposus proteoglycans and dehydration followed, finally, by disc shrinkage and direct reduction of root compression[8]. Interestingly, we observed significantly reduction in ADC of the treated discs around the second month and herniation volume reductions around the sixth month of follow up,  after oxygen-ozone(O2-O3) discolysis, more frequent in the responders group than in the non responders group. In our experience the finding of a statistically significant decrease in the ADC of discs after ozone therapy could be explained by early disc degeneration with a loss of extracellular water and by alterations in the relative proteoglycan content of intervertebral discs . Although we found that mean ADC values in treated discs were lower than those obtained before treatment, previous studies have reported normal or elevated ADC values in severely degenerated discs[9-10]. Therefore on the base of these studies we can affirm that in our experience the treated discs with O2-O3 have not shown an elevated process of degeneration. Nevertheless, a significant number of patients continue to show symptoms after ozone therapy, and then surgery is required after several months. Therefore, it would be useful for both patients and clinicians to know the likely outcome of nonsurgical treatments and the likelihood of future surgery. In particular the high NPV of DWI-ADC analysis ​​can be useful to select those patients who require further treatment with ozone.

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