Lumbar DiscHerniation is a common and frequent disease with an incidence of about 15% in the population. Pain mechanism Nerve root compression theory Nerve root aseptic inflammation theory Autoimmune theory Increased content of pain-causing factors theory Treatment methods Non-invasive: physiotherapy, medication, traction, massage Minimally invasive: mechanical (PLD, PLDD, AMD, MED) and chemical (CL, O3) Invasive: traditional surgical treatment Problems and countermeasures of ozone treatment for lumbar disc herniation Why exactly does lumbar disc herniation Causes low back pain Several theories (Bonneti’s theory) Typing (based on clinical treatment needs) Disc tear, herniation, rupture, prolapse, spinal stenosis, calcification of posterior longitudinal ligament (pseudo-calcification), symphysis. Distinguish between low back pain, leg pain and lumbar and leg pain Low back pain – supraspinous and interspinous ligament pain, posterior spinal nerve entrapment, lumbar transverse process syndrome, herniated disc affecting the dura, small joint dysfunction. Leg pain – herniated disc, pear-shaped muscle syndrome Hip pain DD herniated disc, gluteal epicondylar nerve Correct diagnosis Definite lesion disc Image Protrusion site consistent with symptoms Protrusion not obvious Symptoms obvious Protrusion obvious Symptoms not obvious Protrusion inconsistent with symptoms Examination Straight leg raise Knee tendon reflex Back extension muscle strength Achilles tendon reflex Ozone action on disc tissue Animal test (relationship between degree and tissue destruction) Animal test of Muto (dog disc) Treatment concept Solution of herniation Solution of clinical symptoms Gas distribution Diffusion – posterior, anterior, lateral Is artificial rupture of the fibrous ring necessary? Anterior rupture Application of Decompresser How to resolve Many methods Dr. Jose, Spain, method Kumar, India Method Postoperative evaluation Immediate efficacy, intermediate and long-term efficacy Primary and secondary symptoms Numbness, phantom limb pain VAS score Clinical classification of lumbar disc herniation Fibular ring tear Nucleus pulposus hypertension Nerve root inflammation Nucleus pulposus prolapse Sympathetic nerve type Spinal stenosis Posterior longitudinal ligament calcification Fibular ring tearing type manifesting as discogenic back pain is the main manifestation of disc herniation without obvious disc herniation on imaging, but positive findings on imaging The degree of fibular ring tearing has grades 0 to 5 Ozone therapy is effective Dallas grading scale Grade 0: normal shape of the nucleus pulposus on contrast Grade 1: radiolucent tearing to 1/3 of the border inside the fibular ring Grade 2: radiolucent tearing extending to 1/3 of the border in the fibular ring Grade 3: radiolucent tearing extending to 1/3 of the border outside the fibular ring Grade 4: radiolucent tearing extending to 1/3 of the border outside the fibular ring Grade 4: Tearing beyond the outer 1/3 border of the annulus on the basis of grade 3 up to 30 degrees around the periphery of the disc Grade 5: Full tear with contrast leakage outside the annulus medullaris High pressure type manifesting as bulging or herniated disc High pressure of the nucleus pulposus without rupture of the annulus fibrosus Good decompression effect, immediate results Slow ozone effect, rebound Inflammation of nerve roots Aseptic inflammation of nerve roots stimulated by spillage of the nucleus pulposus after rupture of the annulus fibrosus Low back pain with radicular pain Ozone is effective and immediate Sympathetic type Lateral disc herniation compresses lumbar sympathetic nerve Chills and fever in lower extremities predominate Sympathetic nerve destruction should be performed Spinal stenosis Bony or soft tissue spinal stenosis Symptoms in both lower extremities, intermittent claudication Ozone treatment is effective for about 1 to 3 months Recurrence is possible Surgery is possible Myeloproliferative type Radicular symptoms are heavy Collagenase is effective, but risky Ozone treatment requires multiple accesses Ozone (oxytocin) is simple, safe, minimally invasive, less expensive, and almost free of serious complications (nerve root, spinal cord injury, infection) Nerve root block can be performed. “Repeated injections are needed for 3-4 days in hospital for those with poor results. Mechanism of action The mechanism of action of ozone on herniated discs is not fully understood. Professor Bocci, a physiologist at the University of Siena, Italy, is an authority on the basic research of ozone therapy. He believes that the mechanism of action of ozone on herniated disc has four main aspects: (1) oxidation: oxidation of proteoglycans in the nucleus pulposus, which causes the herniated nucleus pulposus to retract and achieve mechanical decompression; (2) anti-inflammatory effect: by antagonizing the release of immune factors in the inflammatory response, dilating blood vessels, improving venous (2) anti-inflammatory effect: by antagonizing the release of immune factors in the inflammatory response, dilating blood vessels, improving venous reflux, reducing nerve root edema and adhesions, thus achieving pain relief; (3) inhibition of immune response: glycoproteins and β-proteins released after fibrous ring rupture act as antigenic substances, causing the body to produce an immune response, and ozone has the effect of inhibiting immunity (4) analgesic effect: the analgesic effect of ozone directly affects the surface of the intervertebral disc, adjacent ligaments, small joint synapses and These nerve endings are activated by inflammatory factors and chemical substances (such as substance P or phosphatase A2) released from the protruding nucleus pulposus and produce pain. Ozone treatment concentration is 10~80ug/ml; Italy advocates the use of 27ug/ml Be sure to use medical pure oxygen, otherwise harmful gases will be produced Due to the large amount of nitrogen in the air, the input air will produce a large amount of NOx causing human damage About the combined application of ozone and other technologies Ozone is not a disinfectant; understand the treatment concept and mechanism, choose a reasonable treatment method High interdiscal pressure –incision and aspiration, laser, plasma Nerve root inflammation predominant –ozone + nerve root block Massive prolapse and prolapse –ozone + surgery Spinal stenosis and posterior longitudinal ligament calcification –surgery