The Clinical Efficacy And Safety Of Intradiscal Injection With Collagenase And Oxygen-ozone Gas Mixture To Treat Lumbar Disc Herniation In Patients With Grade I Degenerative Spondylolisthesis By The Guidance Of Computed Tomography

The lumbar disc herniation with Grade I degenerative spondylolisthesis is one of themajor causes leading to clinical lumbocrural pain.Clinical manifestation is includingosphyalgia, sciatica, intermittent claudication and so on.The basic treatments areconservative treatment and surgical treatment.Conservative treatment is suitable forpatients with light clinical symptoms and signs.But surgery is more effective forcomplicated trauma.According to the rapid development of scientific technology,improvement of medical equipment and change of medical conception, more and morescholars came to explore the indicative range of injection of collagenase and ozonechemical dissolution and achieved positive results.Clinical studies have shown that theminimally invasive treatment of injection of collagenase with ozone is one of the exact,sage and effective ways in curing lumbar intervertebral disc herniation.At present theinjection of collagenase and ozone in treating lumbar intervertebral disc herniationcombined with Grade I degenerative spondylolisthesis is lack of related research in ourcountry.Objective To analyze the clinical efficacy and safety of intradiscal injection ofcollagenase and oxygen-ozone gas combined with the guidance of CT in treatinglumbar disc herniation with Grade I degenerative spondylolisthesis.Methods From January2010to September2011, forty-nine patients who suffered fromlumbar disc herniation with grad I spondylolysis in pain clinic of The First AffiliatedHospital of Anhui Medical University were treated with the method of injection of collagenase and ozone under the guidance of CT therapeutic alliance with the intradiscalinjection of collagenase and oxygen-ozone into the internal and external of thesites.The patients are divided into control group and treatment group in accordancewith the process of the treatment.Clinical effects were evaluated by observing thechanges of visual analogues scales (VAS), taking painkillers and the distance of thesliding vertebrae before the treatment, on postoperative day-7and finally6monthsaccompany with the method of using modified Mac nab on postoperative day-7and atfinal follow-up (6months after surgery) to observe the complications of the treatmentgroup.Results1.Puncture situation49cases of puncture in intervertebral disc are all successfulwith one try.The success rate is100%.2.Complication situation.The two groups ofpatients are taken clinical observation in1to72hours after the treatment.And majorityof the patients have an acid bilges feeling in their lumbar and are given treatment ofdehydration, nutrition neural processing.Three days later the symptoms improvedsignificantly.After the surgery, there are no complications like postoperativeintervertebral disc infection, large blood vessels or nerve damage and localhematoma.3.Clinical efficacy.According to VAS cores, the statistic is8.52±1.13beforethe surgery and it turns to2.48±1.04one week after and2.73±1.08six months after thesurvey.According to painkillers use scores, the statistic is2.85±0.82before the surgeryand it turns to0.63±0.31one week after and0.51±0.21six months after thesurvey.According to the shift distance of slip vertebral body, the score is1.93±0.33mmbefore the surgery and it turns to2.01±0.14mm one week after and1.96±0.25mm sixmonths after the surgery.The VSA scores and painkillers use scores both decreasedevidently after one week and six months of the surgery.There is a significant differencecompared with the condition before the surgery(P<0.05).The shift distance of slipvertebral body one week after or six months after the survey did not show any significant difference compared with the previous condition(P＞0.05).The improvedMac nab therapeutic effect evaluation were undertaken after one week and six monthsrespectively, and effective rate was85.71%and87.76%.So the difference issignificantly meaningful(P<0.05).Conclusion Injection of collagenase and oxygen-ozone under the guidance of CTachieve an ideal clinical effect as it can relieve painfulness of the patient and improvethe root symptoms with no influence of sliding vertebrae.In conclusion it is a pretty safeand effective minimally invasive method for treatment of lumbar disc herniation inpatients with Grade I degenerative spondylolisthesis.