Bel Ağrısında Ozon Tedavisi
Özet
Bel ağrısı, dünya genelinde yaygın bir halk sağlığı problemi olup yetişkinlerin büyük kısmını hayatları boyunca etkilemektedir. Non-invazif konservatif tedavilerden fayda görmeyen hastalarda perkutan ozon tedavisi, minimal invazif, basit, hızlı ve düşük komplikasyon riskine sahip avantajlı bir alternatif olarak öne çıkmaktadır. Ozon gazının (O₃) medikal kullanımı 19. yüzyıla, bel ağrısındaki uygulamaları ise 1989 yılına kadar uzanmaktadır. Tıbbi ozon, vücutta ılımlı bir oksidatif stres yaratarak antioksidan enzimleri indüklemekte ve antiinflamatuar ile analjezik etkiler göstermektedir. Uygulama yöntemleri arasında paravertebral kas içi, intradiskal, intraforaminal ve kaudal epidural enjeksiyonlar yer almaktadır. İntradiskal uygulamada nükleus pulposus içindeki makromoleküler yapı bozularak disk içi basınç, ağrı ve sinir kökü basısı azaltılır. Favizm, kanama bozuklukları, hipertiroidi ve kontrolsüz kardiyovasküler hastalıklar gibi durumlarda ise ozon tedavisi kontrendikedir. Nadiren de olsa pnömosefali, retinal hemoraji, vazovagal senkop ve gaz embolisi gibi teknik kaynaklı komplikasyonlar bildirildiğinden, klinik standardizasyonu sağlamak ve optimum faydayı netleştirmek adına daha fazla randomize kontrollü çalışmaya ihtiyaç duyulmaktadır.
Low back pain is a common public health problem worldwide, affecting most adults during their lifetime. In patients who do not benefit from non-invasive conservative treatments, percutaneous ozone therapy stands out as an advantageous alternative since it is minimally invasive, simple, fast, and carries a low risk of complications. The medical use of ozone gas (O₃) dates back to the 19th century, and its application in low back pain dates back to 1989. Medical ozone creates mild oxidative stress in the body, inducing antioxidant enzymes and exhibiting anti-inflammatory and analgesic effects. Application methods include paravertebral intramuscular, intradiscal, intraforaminal, and caudal epidural injections. In the intradiscal application, the macromolecular structure within the nucleus pulposus is disrupted, thereby reducing intradiscal pressure, pain, and nerve root compression. Ozone therapy is contraindicated in conditions such as favism, bleeding disorders, hyperthyroidism, and uncontrolled cardiovascular diseases. Although rare, technique-related complications such as pneumocephalus, retinal hemorrhage, vasovagal syncope, and gas embolism have been reported, so more randomized controlled trials are needed to ensure clinical standardization and clarify optimum benefits.
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