Intradiscal pain (confirmed through provocative discography with manometry) is probably the most difficult type of chronic low back pain to treat. Unfortunately, it is a common cause of low back pain, especially before age 65.
For a long time, arthrodesis surgery (i.e. lumbar spinal fusion) was the only treatment available.
Physiatrists at the Institut de Physiatrie were the first in Canada to offer percutaneous treatments for this problem.
The first two treatments that started in the late 1990s were intradiscal electrothermal therapy (IDET: denervation of the posterior annulus fibrosis by threading a catheter into the disk under fluoroscopic guidance in order to heat and burn the pain receptors) as well as biacuplasty (radiofrequency annular ablation using two catheters).
Other treatments, such as platelet-rich plasma (PRP) and intradiscal ozone injections, have since replaced intradiscal electrothermal therapy (IDET) and are offered at the Institut de Physiatrie du Québec.
These treatments are performed for disc pain due to annular tearing or a herniated disc. Provocative discography with manometry can be done first to confirm the diagnosis and the origin of the pain, but it is not always essential.
The specialist will discuss and choose the best treatment with the patient based on various criteria.
In some cases, disc pain can be found in a more degenerated disc. In such cases, the preferred treatment is typically an injection of a mix of ozone (O3) oxygen (O2) prepared using an ozonation tube to transform O2 into a gaseous mix of O2 and O3 at a predetermined concentration.
Oxygen-ozone injections act directly on the disc by causing vascular micro-degeneration that reduces the disc volume. Ozone also has anti-inflammatory and antioxidant properties that prevent the spread of substances that activate the inflammatory process such as PGE2 and bradykinin. Ozone also has an analgesic effect.
Improvement begins approximately two months after the injection, peaks at around six months and may continue for a few more months.
The injection technique is similar to other percutaneous techniques under fluoroscopic guidance.
The procedure is performed on one, maximum two, intervertebral discs.
With the patient lying on the stomach, the skin is disinfected and a local anesthetic is applied.
A needle is inserted under fluoroscopic guidance into the disc(s) requiring treatment. After ensuring that the needle is properly positioned, ozone is injected into the disc(s).
A one-week leave of absence from work is recommended following the procedure. It is not necessary to wear a corset.
Increased pain may occur for a few weeks following the intradiscal PRP injection. Applying ice and taking an analgesic help to reduce pain.
Complications are essentially related to the injection, the anatomy involved and the substances injected. The risk of hemorrhaging is rare. The risk of intradiscal infection is greatly reduced due to ozone’s antiseptic effect.
Intradiscal ozone injection is contraindicated during pregnancy and for anyone with an active infection.