Eficacia de la aplicación de ozono epidural y paravertebral a una concentración de 50 μg/ml en pacientes con dolor crónico secundario a síndrome postlaminectomía

摘要

Introduction: Chronic pain is a condition that affects the physical and psychological health of patients. Postlaminectomy syndrome is the onset or persistence of back pain and/or radicular pain in a patient who has had one or more surgical procedures on the spine. Objective: To evaluate the effectiveness of the administration of epidural and paravertebral ozone at a concentration of 50 μg/ml in patients with chronic pain associated with lumbar postlaminectomy syndrome. Material and methods: Between July 15 and December 30 2010 a prospective study was carried in 30 patients of both gender, aged between 18 and 85 years, who had a diagnosis of chronic pain secondary to lumbar postlaminectomy syndrome. The average initial EVA score was 6.8/10. The first injection was performed with intravenous sedation under fluoroscopic control of the lumbosacral region; then was administered through a volume flow rate 20 ml of ozone at a concentration of 50 μg/ml in the epidural space and bilateral paravertebral muscles of the lumbar spine (L3, L4 and L5) with 10 ml of ozone at the same concentration at each level. In total, the infiltrated volume was 60 ml. The infiltration of the paravertebral region was repeated at the same volume and concentration, at intervals of 7 days for 3 consecutive weeks. To measure the effectiveness of treatment was evaluated pain intensity considering the average initial and final visual analogue scale (VAS). As measurement for functionality was used the Oswestry Disability Index, which was evaluated prior to infiltration and at 4 and 8 week. Statistical analysis was performed using the Statistical 7.0, using the Friedman test for the two main variables, and descriptive statistics (mean and standard deviation) for the analysis of other data. A p < 0.05 was taken as statistically significant. Results: We studied 30 patients, all with moderate pain (initial EVA 6.8/10). The ages ranged from 34 to 62 years with mean and standard deviation of 50.9 ± 7.2 years. 21 patients (70%) were female and 9 (30%) were men. Statistically significant differences were in the mean Oswestry indices (F = 10.9058, p = 0.000002) and those of the EVAs (F = 43.3314, p < 0.01) however there was no clinical change, as patients continue with moderate disability and pain. Conclusions: Epidural and paravertebral administration of ozone at a concentration of 50 μg/ml, did not prove to be useful in relieving chronic pain and improve functionality in patients with moderate pain secondary to postlaminectomy syndrome.