Ozonucleolysis for slipped/prolapsed Disc

Dr (Maj) Pankaj N Surange
MBBS, MD, FIP
Interventional pain and spine specialist
09871985514

Ozone may be a wonder molecule to the clinicians though its potentials yet to be fully explored. It has role in controlling bacterial, fungal & viral infections including AIDS, treating non-healing ulcers, Rheumatoid and other kinds of arthritis, different kind of skin diseases and many others.

What is ozone?

Ozone is a tri-atomic Oxygen molecule, O3, with a different molecular structure than Oxygen. Its name is derived from the Greek word ozein meaning “to smell”. At room temperature, Ozone is a colorless gas with a characteristic odor (similar smell after thunderstorms, at high altitudes or near the sea etc). At ground level its concentration 0.03 - 0.04 ppm. Ozone in the atmosphere is produced by action of UV rays and thunderstorm on the atmospheric Oxygen; but Medical Ozone is produced from pure medical grade oxygen with the help of high voltage electrical discharge. Medical ozone is a mixture of oxygen and ozone of different concentration. Medical ozone is always freshly prepared on site (in a special generator) for immediate administration. A trained physician according to the medical indication and the patient’s condition determines the exact dose of ozone.

Safety and efficacy of Ozone therapy

Treating patients with ozone is not a new procedure. The first ozone generators were developed by Werner von Siemens in Germany in 1857, and 1870 saw the first report on ozone being used therapeutically to purify blood, by C. Lender in Germany.
During World War 1, ozone was used to treat wounds, trench foot, gangrene and the effects of poison gas. Dr. Albert Wolff of Berlin also used ozone for colon cancer, cervical cancer and decubitus ulcers in 1915. Today, after 125 years of usage, ozone therapy is a recognized modality in many nations: Germany, France, Italy, Russia, Romania, Czech Republic, Poland, Hungary, Bulgaria, Israel, Cuba, Japan, Mexico, and in five US states. It was also used extensively to treat war wounds during World War-II.
It was not popularized before, as ozone resistant materials were not used to produce ozone generators. Also the exact concentration of ozone was unknown. Former Ozone generators are either UV light Ozone generators or plasma type Ozone generators. Here, it was very difficult to know the precise concentration of ozone. Now with the present Corona-discharge Ozone generators, it is possible to know the exact concentration of Ozone. Also, by changing the current or the oxygen flow, Ozone concentration can be precisely modified.
Ozone has been found to be an extremely safe medical therapy, free from side effects. In a 1980 study done by the German Medical Society for Ozone Therapy, 644 therapists were polled regarding their 384,775 patients, comprising a total of 5,579,238 ozone treatments administered. There were only 40 cases of side effects noted out of this number that represents the incredibly low rate of .000007%. Ozone Therapy has been described as the safest known medical therapy.

Indications of Ozone therapy

Among the various diseases presented with pain the following has been treated with very good results; e.g. rheumatoid arthritis, systemic lupus erythemoatosis, scleroderma, polymyositis/fibromyositis, ankylosing spondylitis, osteo-arthritis, Reiter syndrome, psoriasis, synovitis, gout, chrondrocalcinosis, pyrophosphate arthropathy, calcific peri-arthritis, calcific tendinitis, calcinosis and inter-vertebral disc prolapse. In my Pain Clinic I have been treating osteo-arthritis of knee, trigger point injections for fibromyalgia/ Myofascial pain, and inter-vertebral disc prolapse or slipped disc successfully.

How Ozone should be administered?

There are different methods like injections of ozone/oxygen mixture; insufflations through rectum; treating with ozonated water (drinking, dressing wound/ulcers etc.); auto-transfusion of ozonated blood, application of ozonated oil and so on depending on type and site of disease. But for treatment of different pain we use injection of different concentrations of ozone gas only. Ozone molecule is not stable. It has a half-life of 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 for immediate administration. Only Ozone resistant syringes can be used for injecting it. The contraindications for treatment with ozone are only a few. They are active bleeding from any site, pregnancy, and active hyperthyroidism.

Mechanism of action

The mechanisms of action of ozone are many. Most of its actions are due to the active oxygen atom liberated from breaking down of ozone molecule. Besides its action as bactericidal, fungicidal, viricidal agent, it activates cellular metabolism, modulates the immune system & increases and activates body's own antioxidants and radical scavengers. In the treatment of pain different other mechanism acts. There is enhancement of circulation. Ozone reduces or eliminates clumping and red cell. Its flexibility is restored, along with oxygen carrying ability (due to the stimulation of 2,3-diphosphoglycerate). Oxygenation of the tissues increases as the arterial partial pressure increases and viscosity decreases. Ozone also oxidizes the plaque in arteries, allowing the removal of the breakdown products, unclogging the blood vessels. All these leads to an increase in the amount of oxygen released to the diseased tissues. There is also reduced formation of inflammatory mediators like different prostaglandins and so there is an anti-inflammatory action.

Ozone in PIVD/Slipped disc

In case of prolapsed inter-vertebral disc (or, slipped disc) different other mechanism acts. Inter-vertebral disc is filled with nucleus pulposus which is a jelly like material which holds water (90% of disc material is water). When ozone is injected into the disc the proteo-glycan bridges in the jelly-like material are broken down and they no longer capable of holding water. As a result disc shrinks and mummified which is equivalent to surgical discectomy and so the procedure is called ozone discectomy or ozonucleolysis. It has been published in ANESTHESIA AND PAIN journals that up to 85% of disc operation can be avoided with these non-surgical interventions. Success rate is about 88% which is comparable to surgical discectomy (50% to 90%). Complications are remarkably low and much less than surgery.

Future

Ozone is gradually gaining popularity in various medical fields especially in pain management. Newer modification in techniques and administration of ozone, more and more publication of scientific materials in the medical journals and animal studies have made it more acceptable to the medical community and gradually it is becoming more popular.