(A) equipment and materials
1, X-ray imaging equipment: high-definition X-ray machine capable of lumbar spine frontal and lateral television fluoroscopy, C-arm X-ray machine is preferred.
2, X-ray machine room: disinfection equipment, good ventilation, preoperative hand washing preparation room.
3, ozone generator (must be qualified products, nationally recognized, complete with three symptoms, preferably imported ozone generator)
(II) Indications
1, simple lumbar disc herniation, protrusions <10mm or less.
2. Age-related degenerative changes of multi-segmental discs with herniation.
(C) Relative indications
1.Mild spinal stenosis with herniation.
2.Recurrence of lumbar disc herniation after surgical treatment.
3, lumbar disc herniation with partial calcification.
(IV) Contraindications
1.Bony spinal stenosis or hypertrophy of the ligamentum flavum;
2, combined with severe cauda equina symptoms;
3. Calcification or ossification of the herniated disc;
4, vertebral body more than II degree slippage;
5, bleeding tendency;
6, allergic body; psychiatric or intraoperative patients who cannot cooperate;
7, heart, liver, lung, brain serious organic disorders.
(E) Ozone intervention operation methods and steps
1, positioning, local skin disinfection: the patient lies on the fluoroscopy bed, a pillow on the abdomen, 8-10 cm next to the midline of the corresponding vertebral space, and use gentian violet as the puncture point marker. Disinfect the skin with the puncture point as the center, and lay a disinfectant towel.
2.Local anesthesia: local anesthesia is done layer by layer with 1% lidocaine from the puncture point, and it is not appropriate to anesthetize the nerve root.
3, puncture: from the skin mark point, the needle body and lumbosacral at an angle of 45º ~ 60º, aligned with the corresponding intervertebral space puncture. l5 ~ S1 intervertebral disc puncture, the needle body tilted to the cephalad side about 20º ~ 25º, the tip of the needle to pierce the fiber ring when there is a sense of falling.
4, needle tip position: orthogonal fluoroscopy needle tip up to the midline, lateral fluoroscopy needle tip is located at the junction of the middle and posterior 1/3 of the intervertebral disc.
5.Ozone injection: slowly push 8-20 ml of ozone into the disc. When the intervertebral disc fibrous ring is not broken, the ozone is pushed and injected into the disc with greater pressure, and it is more difficult to push the ozone into the disc. When the manual pressure suddenly decreases, the fibrous ring may be connected to the epidural space and ozone may enter the epidural space of the spinal canal. Lateral fluoroscopy shows a translucent gas shadow along the posterior edge of the vertebral body.
6, remove the puncture needle and apply a local band-aid.
7, postoperative position: postoperative supine, hip flexion and knee flexion position.
(F) Postoperative treatment.
1.Postoperative symptoms are obviously relieved, no special treatment is needed.
2, postoperative symptoms are still more obvious patients can be infused with fluids, internal anti-inflammatory, dexamethasone, neurotrophic drugs, mannitol dehydration, reduce nerve root edema to relieve symptoms.
3.Bed rest for 5-7d, can get up and move around with the help of waist circumference.
4.Sacral canal therapy: for individual patients, it can be combined with sacral canal therapy, infusion of vitamin B1, B12, dexamethasone, etc.
5.According to the patient’s symptom relief, ozone can be repeatedly injected into the diseased intervertebral disc for treatment after two weeks.