A Comparative Study On Two Puncture Approaches To Lumbar Disks Under MRI Guidance

Objective To explore the advantages and disadvantages of two percutaneous puncture approaches to lumbar intervertebral disks under MRI guidance.Methods 73 patients with lumbar disk herniation (LDH),116 lumber intervertebral disks were punctured under the real-time guidance and monitoring of optical instrument mounted to the 0.23T open MR scanner.67 intervertebral disks(42 patients) were punctured by medial posterior approach (MPA) and the others 45(31 patients) via posterolateral approach(PLA). We assessed effects of the two different methods according to times of puncture, puncture time and complications.Results All punctures were performed successfully. Compared MPA group with the PLA group, times of puncture and puncture time of L3-4, L4-5 were similar and there was no significant difference statistically. As for L5/S1 lumbar intervertebral disk, both numbers of puncture (1.43±0.68 vs 2.14±0.77) and puncture time(9.02±2.50 vs 14.61±3.93) were significantly different (p<0.05). Whereas there was no significant difference in short-term complications (9.5% vs 6.5%) between two groups(p>0.05).Conclusion MRI guided percutaneous lumbar disk puncture by MPA is safe and feasible, its times of puncture and puncture time were decreased more significantly than that of PLA. Objective To compare the Oxygen-Ozone therapeutic effect and safety on lumbar disk herniation(LDH) punctured by medial posterior approach(MPA) or by posterolateral approach(PLA) under MRI guidanceMethods Under the real-time guidance and monitoring of optical instrument mounted to the 0.23T open MR scanner,74 patients with LDH(116 lumber intervertebral disks) were treated with Ozone-Oxygen injection by different puncture approaches. All patients received an intradiscal (10-15ml), periganglionic (10-15ml) injection of an oxygen-ozone mixture at an ozone concentration of 35-45μg/ml and a periganglionic injection of corticosteroid, vitamin and anesthetic mixture. Patients were in hospital for 3 days, short term outcome were assessed according to symptoms improvement and the complications. Mid-long term outcome was assessed after a mean follow up period of between 12 and 24 months by using a modified MacNab method.Results 67 intervertebral disks were treated by MPA and the others(45) by PLA. three days after procedure, the percentage of low back pain, radicular pain and motor deficits improvement was higher in MPA group, compared with PLA group, difference was statistically significant, the percentage of sensory deficits improvement is similar and there was not statistically difference, complication rate is higher in MPA group, but the difference was not statistically significant, these complications dispeared within 24 hours completely. According to mid-long-term outcome assessment, treatment was a success (excellent or good outcome) in 88.1% and deemed a failure (satisfactory to poor outcome or recourse to surgery) in the remaining 11.9% of MPA group, treatment was a success in 67.7% and deemed a failure in the remaining 32.3% of PLA group, the difference in outcome between the two groups was statistically significant (P<0.05), no mid-long term complication was observed in both groups. Conclusion MRI guided Ozone-Oxygen therapy for LDH is safe and feasible, MPA group can get better theraputic effects both on short-term outcome and on mid-long-term outcome than that of PLA group. Objective To compare the clinical outcome between Ozone and ozone combined with diskectomy for lumar disk herniation punctured by medial posterior approach under MRI guidance.Methods Under the real-time guidance and monitoring of optical instrument mounted to the 0.23T open MR scanner,110 patients with LDH were treated by medial posterior puncture approach. Ozone therapy group(A group) received an intradiscal (15-20ml), periganglionic (15-20ml) injection of an oxygen-ozone mixture at an ozone concentration of 35-45μg/ml and a periganglionic injection of corticosteroid,vitamin and anesthetic mixture. ozone combined with diskectomy therapy group(B group) were treated with percutaneous lumbar diskectomybesides oxygen-ozone mixture and corticosteroid,vitamin , anesthetic mixture injection. Patients were in hospital for 3 days, short-term outcome were assessed according to the complication rate and symptom improvement. Medial-long-term outcome was assessed 12～24 months after treatment by using a modified MacNab method.Results 42 patients were treated with ozone thepapy(A group),78 patients received ozone combined with diskectomy therapy(B group). the percentage of low back pain, radicular pain of motor deficits and sensory deficits improvement was higher in both groups three days after procedure, difference in outcome between the two groups was not statistically significant; complication rate is higher in B group, but these complications dispeared within 48 hours completely and was not statistically difference. According to mid-long-term outcome assessment, treatment was a success (excellent or good outcome) in 88.1% and deemed a failure (satisfactory to poor outcome or recourse to surgery) in the remaining 11.9% of group A; treatment was a success in 94.1% and deemed a failure in the remaining 5.9% of group B, The difference in outcome between the two groups was statistically significant (P<0.05), no mid-long term complication was observed in both group.Conclusion ozone combined with diskectomy therapy for lumar disk herniation under MR guidance is safe, feasible and can get a higher rate of immediate symptems improvement, it has a better medial-long-term outcome than that of ozone injection group although its shot-term complitions is higher.