Treatment of Degenerative Disc Disease associated with Modic changes, with ozone therapy. A new therapeutic proposal.
DOI:
https://doi.org/10.7203/jo3t.4.5.2020.14739关键词:
Modic changes, degenerative disc disease, ozone therapy, low back pain.
摘要
Introduction.
Modic Changes (MCs) represent signal changes in the vertebral endplate and subchondral bone region visualized on T1 and T2 weighted magnetic resonance images (MRI). Three types of MCs It have been identified (Types 1 to 3). Modic changes are commonly associated with low-back pain (LBP).
In the last few years scientific papers have shown that one of the causes of MCs (fundamentally, the MCs type 1) is the infection caused by an anaerobic bacterium of very low virulence: Propionibacterium acnes (P. acnes). This bacterium resides on the human skin, oral cavity, intestinal tract, and external ear canal as normal flora. As a consequence of tooth brushing and endodontic-therapy, could invade the blood stream leading to transient bacteremia. The authors propose a treatment which consists of Amoxicillin-clavulanate (500 mg/125 mg) three times a day, at 8-hour intervals, for 90 days/100 days.
Objectives.
Ozone therapy could be the gold standard therapy for MC1 because ozone is a powerful anti-microbial, anti-inflammatory and analgesic agent, which regulates oxidative stress, immune system and oxygen metabolism.
Materials and Methods
Patients with LBP lasting 6 months or more and MC1 confirmed by MRI of lumbar spine L3/L4 or L4/L5 or L5/S1 and who responded with 5 or more points on the VAS scale were treated with three intradiscal sessions of ozone therapy and ten paravertebral sessions.
Results.
Patients who were treated with ozone therapy according to our treatment proposal showed a substantial improvement on VAS comparing the beginning and the end of the treatment. They show a significant difference in pain, and general condition. However, these results were not reflected on ODI scale, neither on the MRI but we could notice certain improvements.
Downloads
Author Biography
Anibal Martin Grangeat, IAOT (Instituto Argentino de Ozonoterapia)
参考
Yue-Hui Z, Chang-Qing Z, Lei-Sheng J, Xiao-Dong C, Li-Yang D. Modic changes: a systematic review of the literature. Eur Spine J. 2008; 17:1289-1299.
Modic MT, Steinberg PM, Ross JS, Masaryk TJ, Carter JR. Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology. 1988; 166:193-199.
Michael TM, Jeffrey SR. Lumbar Degenerative Disk Disease. Radiology. 2007 Oct;225(1):43-61.
Albert HB, Lambert P, Rollason J, Solgaard J, Worthington T, Bach Mogens, Schack H, Vernallis A, Busch F, Manniche C, Elliott T. Does nuclear tissue infected with bacteria following disc herniations lead to Modic changes in the adjacent vertebrae? Eur Spine J. 2013;22:690-696.
Rollason J, McDowell A, Albert HB, Barnard E, Worthington T, Hilton AC, Vernallis A, Patrick S, Elliott T, Lambert P. Genotypic and Antimicrobial Characterisation of Propionibacterium acnes Isolates from Surgically Excised Lumbar Disc Herniations. Biomed Res Int. 2013;2013:1-7.
Stirling A, Worthington T, Rafiq M, Lambert PA, Elliott TSJ. Association between sciatica and Propionibacterium acnes. The Lancet. 2001 Jun 23;357:2023-2025.
Burke JG, Watson RW, McCormack D, Dowling FE, Walsh MG, Fitzpatrick JM. Intervertebral discs which cause low back pain secrete high levels of proinflammatory mediators. J Bone Joint Surg Br. 2002; 84:196-201.
Crock HV. Internal disc disruption: a challenge to disc prolapse fifty years on. Spine. 1986;11(6):650-653.
Albert HB, Sorensen JS, Christensen BS, Manniche C. Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modic type 1 changes): a double-blind randomized clinical controlled trial of efficacy. Eur Spine J. 2013;22:697–707.
Crockett MT, Sean B, van Baarsel KS, Kavanagh C. Modic Type 1 Vertebral Endplate Changes: Injury, Inflammation, or Infection? AJR. 2017;209(1):167-170.
Uquhart DM, Zheng Y, Cheng AC, Rosenfeld JV, Chan P, Liew S, Monira S, Cicuttini FM. Could low grade bacterial infection contribute to low back pain? A systematic review. BMC Medl. 2015 Jan 22;13:13.
Urquhart DM, Zheng Y, Cheng AC. Can bacterial infection by low virulent organisms be a plausible cause for symptomatic disc degeneration? A systematic review. Spine. 2015;40(10):E587-E592.
Shan Z, Zhang X, Li S, Yu T, Liu J, Zhao F. Propionibacterium acnes Incubation in the Discs Can Result in Time-Dependent Modic Changes. A Long-Term Rabbit Model. Spine. 2017 Nov 1;42(21):1595-1603.
Albert HB, Sorensen JS, Schiott B, Manniche C. Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modic type 1 changes): a double-blind randomized clinical controlled trial of efficacy. Eur Spine J. 2013;22:697-707.
Re L, Mawsouf MN, Menendez S, Leon OS, Sanchez GM, Hernandez F. Ozone Therapy: Clinical and Basic Evidence of Its Therapeutic Potential. Arch Med Res. 2008;39(17):26.
Bocci V. How a calculated oxidative stress can yield multiple therapeutic effects. Free Radic Res. 2012 Sep.46(9):1068-1075.
Smith NL, Wilson AL, Gandhi J, Vatsia S, Khan SA. Ozone therapy: an overview of pharmacodynamics, current research, and clinical utility. Med Gas Res. 2017;7(3):212-219.
Risbud MV, Shapiro IM. Role of Cytokines in Intervertebral Disc Degeneration: Pain and Disc-content. Nat Rev Rheumatol. 2014 Jan;10(1):44–56.
Martin BI, Deyo RA, Mirza SK et al. Expenditures and health status among adults with back and neck problems. JAMA. 2008;299(6):656-664.
Stewart WF, Ricci JA, Chee E, Morganstein D, Lipton R. Lost productive time and cost due to common pain conditions in the US workforce. JAMA. 2003; 290:2443–2454.
Slaby O, McDowell A, Brüggemann H, Raz A, Demir-Deviren S, Freemont
T, Lambert P, Capoor MN. Is IL-1b Further Evidence for the Role of Propionibacterium acnes in Degenerative Disc Disease? Lessons From the Study of the Inflammatory Skin Condition Acne Vulgaris. Front Cell Infect Microbiol. 2018 Aug;8:272.
Vo NV, Hartman RA, Patil PR, Risbud MV, Kletsas D, Iatridis JC, Hoyland JA, Le Maitre CL, Sowa GA, Kang JD. Molecular Mechanisms of Biological Aging in Intervertebral Discs. J Orthop Res. 2016 Aug;34(8):1289-1306.
Feng C, Liu H, Yang M, Zhang Y, Huang B, Zhou Y. Disc cell senescence in intervertebral disc degeneration: Causes and molecular Pathways. Cell Cycle. 2016;15(13): 1674-1684.
Kjaer P, Leboeuf-Yde C, Korsholm L, Sorensen JS, Bendix T. A diagnostic imaging study of 40 year-old men and women. Magnetic resonance imaging and low back pain in adults. Spine. 2005; 30:1173–1180.
Albert HB, Manniche C. Modic changes following lumbar disc herniation. Eur Spine J. 2007 Mar 3;16(7):977-982.
Albert HB, Kjaer P, Jensen TS, Sorensen JS, Bendix T, Manniche C. Modic changes, possible causes and relation to low back pain. Med Hypotheses. 2008;70:361-368.
Mehraban F, Seyedarabi A, Seraj Z, Ahmadian S, Poursasan N, Rayati S, Moosavi-Movahedi AA. Molecular insights into the effect of ozone on human hemoglobin in autohemotherapy: Highlighting the importance of the presence of blood antioxidants during ozonation. Int J Biol Macromol. 2018 Nov;119:1276-1285.
Bocci V, Borrelli E, Zanardi I, Travagli V. The usefulness of ozone treatment in spinal pain. Drug Des Dev Ther. 2015;9:2677-2685.
Song M, Zeng Q, Xiang Y, Gao L, Huang J, Huang J, Wu K, Lu J. The antibacterial effect of topical ozone on the treatment of MRSA skin infection. Mol Med Rep. 2018;17:2449-2455.
Downloads
已出版
How to Cite
-
摘要676
-
PDF 334
期
栏目
License
Journal of Ozone Therapy applies the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY NC 4.0) license to works we publish.
Under this license, authors retain ownership of the copyright for their content, but allow anyone to download, reuse, reprint, modify, distribute and/or copy the content as long as the original authors and source are cited. No permission is required from the authors or the publishers.
You may not use the material for commercial purposes.
Appropriate attribution can be provided by simply citing the original article, provide a link to the license, and indicate if changes were made.
You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
Similar Articles
Most read articles by the same author(s)
Make a Submission
语言
消息
关键字
