Introduction: Oxygen ozone gas mixture as a newly prescribed substance became popular among clinicians to relieve low back pain in discogenic patients as an alternative method rather than surgery. It is believed multiple metabolic pathways intervein within its site of action with nucleus pulposus. We developed this study to uncover whether this combination could be helpful in the middle Eastern population or not.   Methods:  In the present randomized clinical trial study, we included 40 patients with L1 to S1 disc herniation based on MRI verification within years 2018-2019 who did not respond to 6 weeks of physiotherapy. All patients were followed with a mean time of 12 weeks after injection, and pain VAS score and SF-36 score were performed for all patients. The severity of disc herniations was evaluated by a spine surgeon within the Michigan State University (MSU) classification frame.   Results: Nine out of 40 patients were unexpectedly excluded during our study due to their absence for follow-up. The present study showed that the mean distribution of the patient’s sex, age, BMI, smoking was not contrasting between the two groups (p>0. 05). The current study represented two groups were identical regarding Lumbosacral segment involvement during 12 weeks of our survey (p>0. 05). SF-36 score graphical inclination was equivalent in both intervention and control groups. The mean VAS score was primarily decreased after two weeks in the intervention group in comparison with the control group, but it failed to thrive in the following weeks and was raised afterward. On the other hand mean VAS score for the control group (6. 1,95% CI: 5. 4-6. 8) proceeded with a steady slope notably lower than the intervention group (7. 5,95% CI: 6. 9-8. 2,P<0. 001). Conclusion: In conclusion, referring to statistical outcomes inferred from our study, we understood oxygen-ozone mixture injection is not beneficial in patients with low back pain.

Background: Kyphoplasty (KP) has been widely applied to treat painful osteoporotic vertebral compression fractures (VCFs). However, knowledge about sequelae is still inadequate. This study aimed to assess outcomes following balloon KP in patients with osteoporotic VCFs. Methods: A total of 251 patients were included and classified into two groups: group A included 31 patients with braces for one month after KP, and group B contained 220 patients without braces. Patients with Intradiscal bone cement leakage were divided into two groups according to spinal X-ray imaging with Round-type (n = 2) and Spike-type (n = 9). Operating efficacy was evaluated via a comparison of the visual analog scale (VAS) and Oswestry Disability Index (ODI) before and after KP. Complications such as adjacent vertebral fractures (AVFs) and remote vertebral fractures (RVFs) were observed. Results: 361 vertebral bodies, including 153 thoracic vertebrae (42. 4%) and 208 lumbar vertebrae (57. 6%) were treated. Mean age of patients was 73. 3 [standard deviation (SD) = 6. 4] years and 72. 9% were women. Mean follow-up duration was 22. 8 (SD = 13. 2) months. Operation average time was 35. 2 (SD = 9. 3) minutes. Average intraoperative fluoroscopy was 23. 6 (SD = 9. 8) times. Average volume of bone cement injected into each vertebral body was 3. 7 (SD = 0. 9) ml. We observed 18 AVFs and nine RVFs within 1-31 months of surgery. The remote fracture was 0% in group A and 4. 1% in group B, which was also a statistically significant difference (P < 0. 05). The AVFs were 78% in group of Spike-type and 0% in group of Round-type, which shows a significant difference between the groups (P < 0. 05). All groups had significantly improved VAS and ODI at each follow-up time. Conclusion: KP is an effective treatment for the management of osteoporotic VCFs, but it seems that intra-disc leakage with Spike-type increases the risk of AVFs. We recommend patients wear braces for at least one month after KP to reduce pain and new fractures.

Background and Importance: During a lumbar discectomy, the surgical knife might be broken and embedded deeply within the disc space. In some cases, it may be impossible to remove the broken blade during the initial surgery despite allocating several hours for this purpose. This fact may justify a subsequent surgical session. However, the eventual retrieval of the broken scalpel during a second surgical encounter can likewise be a very daunting challenge. Case Presantation: An L4-L5 discectomy in a young boy was complicated by the presence of an Intradiscal broken surgical knife blade. The broken blade was successfully retrieved in a subsequent surgical session via the extended extraforaminal approach. Conclusion: The occurrence of an Intradiscal retained broken scalpel has been rarely discussed within medical literature. There exist a wide variety of different approaches used for such a needed retrieval. The extended extraforaminal corridor has yet to be described within the context of medical journalism.

This study intends to present a biomechanical model of the lumbar spine applying the finite element method in order to evaluate the behavior of the spine with disc degeneration. The high rates of patients suffering from this phenomenon encouraged us to study the effects of disc degeneration on spinal response. In the proposed method, the entire lumbar spine, including the vertebrae L1 to S1, were simulated. Degeneration of the disc was also modeled in three different ways, decreasing disc height, changing the mechanical properties of the nucleus, and changing the properties of ligaments and collagen fibers. This degeneration was considered simultaneously for both L4-5 and L5-S1 discs, which is referred to as double-level degeneration in this study. After modeling and applying synthetic loading (bending moments with a follower load), the analysis was performed via ABAQUS software. The results, including Intradiscal Pressures and the intervertebral rotation, were also compared with experimental data for further verification. The findings of this study illustrate that double-level disc degeneration reduces Intradiscal Pressures in L4-5 and L5-S1 discs. However, the Intradiscal Pressure of a degenerated disc does not change the Intradiscal Pressure of other adjacent discs. Moreover, in extension and axial rotation loading, increasing disc degeneration would lead to an increase in intervertebral motion.

Background: Disk herniation (DH) is one of the most common disk lesions, inducing low back pain (LBP). Various therapeutic options have been proposed for treatment of disk herniation (DH). Intradiscal injection of ozone has been suggested for treatment of DH.Objectives: To determine the effect of Intradiscal ozone injection on pain score and disability in patients with LBP from disk prolapsed.Patients and Methods: Patients with LBP diagnosed with DH were enrolled in this clinical trial study. After prep and drape the area and under the fluoroscopy guide (c-arm), Intradiscal injection of ozone/oxygen mixture (4 mL, 40 mg/mL) was performed. Pain score and functional ability of the patients according to Oswestry Disability Index (ODI) were measured prior to the injection (baseline) and then at 2 and 4 weeks and then at 3 and 6 months after the injection.Results: Thirty patients (17 females, 13 males) with the mean age of 58.6 y (range, 42-73 y) enrolled in the study. The mean ± standard deviation (SD) of pain score before intervention was 8.1±0.8. After two weeks, it was reduced to 3.2±0.6 (P<0.001) and finally dropped to 2.0±0.6 sixth months after intervention (P=0.0001). Functional status of ODI was 28.5±2.1 before intervention and showed significant reduction after two weeks (with the mean of 12.3), and it was almost sustained till sixth months after intervention, with the mean of 11.4 (P=0.001).Conclusions: Altogether, ozone had significant positive effects on patients with disk herniation unresponsive to other conservative and minimally invasive treatments.

Introduction: Cement augmentation in vertebrae is used to promote mechanical strength after spinal fracture and recently vertebroplasty gaining popularity as a treatment for patients. The numerical simulation could be helpful to enhance the quality of treatments such as vertebroplasty via exact modeling of the lumbar spine. Materials and Methods: In this study, a three-dimensional finite element model created from CT images of L1-L3. According to clinical observation and recent studies, we consider that L2 augmented with two different volumes in 10 different distributions. Loadings were assumed to be pure momentum which applied in three anatomical directions (axial rotation, flexion, and lateral bending). Results: Our results were validated with experimental data which shows segments range of motion, ligaments forces, and Intradiscal Pressure had good agreement with our results. Cement augmentation increases max Von Misses stress in L2 cancellous bone and Increment in Cement volume has the same result. Cement augmentation increases L1-L2 Intradiscal Pressure. Cement augmentation decreases segments range of motion. Finally, Cement augmentation increases total stiffness of model. Conclusion: Taken together, vertebroplasty as a well-known method to treat the fractured vertebra, could be optimized to enhance patients' range of motion and decrease the complication of treatment.