lunes, 27 de agosto de 2012

OZONOTERAPIA EN HERNIAS DISCALES: INFORMACION PRACTICA

1. GENERALIDADES

El sobrepeso, las malas posturas, movimientos violentos, levantar pesos de forma incorrecta son algunos de los factores que pueden debilitar los discos intervertebrales.

El disco intervertebral actúa como un cojín amortiguador entre dos vertebras. Consta de tres partes:

1. Núcleo Pulposo. Es una estructura formada por agua añadida a una matriz de proteoglicanos y colágeno.
2. Anillo Fibroso. Consta de 20 laminillas de de fibras colágenas que rodean al núcleo pulposo
3. Platillos Cartilaginosos. Recubren la superficie superior e inferior del disco y lo unen a los cuerpos vertebrales.

En la hernia de disco parte del disco intervertebral (núcleo pulposo) se desplaza hacia la raíz nerviosa, la presiona y produce lesiones neurológicas derivadas de esta lesión.


2. COMO SE TRATAN LAS HERNIAS DE DISCO?

Las primeras medidas para tratar una hernia de disco son conservadoras, con reposo, analgésicos, antiinflamatorios, fisioterapia, etc. Cuando no mejoran los síntomas y se confirma el diagnóstico de hernia de disco mediante RX, Resonancia Magnética o TAC es cuando se plantea su tratamiento quirúrgico.

El tratamiento con Ozono es una nueva forma de terapia de las hernias discales. Es una técnica ampliamente utilizada en Italia donde se inició en el año 1996, habiendo sido tratados más de 6000 pacientes. Los resultados obtenidos hasta la fecha son similares a los obtenidos mediante cirugía (y/o microcirugía), ofreciendo la ventaja de ser un tratamiento ambulatorio realizado con anestesia local, sin contraindicaciones (sólo el favismo y el hipertiroidismo con nódulos activos son contraindicaciones a la terapia con ozono) ni efectos secundarios.

La hernia de disco no produce solamente un efecto compresivo sobre la raíz nerviosa, sino que además produce substancias neurotóxicas que irritan dicha raíz, aparte de los edemas inflamatorio y vascular que se forman en los agujeros de conjunción.

El mecanismo de acción del ozono es el siguiente:

- El ozono inyectado en la musculatura paravertebral estimula la producción de enzimas antioxidantes, neutralizándose así los productos tóxicos liberados por la ruptura del núcleo pulposo responsables de la inflamación del nervio. Así mismo la acción analgésica del ozono hace disminuir la contractura muscular de defensa que, de forma refleja, se activa para proteger la zona de la hernia discal.

- Inyectado en el disco acelera la degradación de los polisacáridos en el núcleo pulposo con lo que disminuye el volumen del material herniado que provoca la compresión del nervio.

Se ha observado que algunos pacientes afectos de hernia discal no intervenidos quirúrgicamente y tratados solamente con analgésicos con el tiempo dejan de presentar síntomas , sólo que esto puede llevar varios meses o años en ocurrir; el ozono lo que hace es acelerar este proceso, de manera que el mismo resultado se obtiene en unas pocas semanas.


3.  INDICACIONES DE LA OZONOTERAPIA EN LA PATOLOGÍA DE LA COLUMNA VERTEBRAL

- HERNIA DISCAL CERVICAL BLANDA
- HERNIA DISCAL DORSAL
- HERNIA DISCAL LUMBAR: PROTUSIONES GRADO I Y II EXTRUIDAS GRADO I Y II SECUESTRADAS
- FIBROSIS POSTQUIRURGICA
- SÍNDROMES FACETARIOS

NO está indicada esta técnica en los casos de compresión de cola de caballo o en ciáticas paralizantes.

La Ozonoterapia no tiene los inconvenientes de la cirugía abierta (Fibrosis postquirúrgica, Disminución del Foramen, Riesgo anestésico, etc.), respetando la anatomía vertebral y devolviendo al paciente a la vida activa de forma precoz.


4. FORMAS DE ADMINISTRACIÓN Y TRATAMIENTO

El tratamiento de hernias discales se realiza en tres fases:

1. Infiltraciones paravertebrales: Inyecciones en la musculatura paravertebral (habitualmente 12-15 sesiones). Se practica en la consulta de la Unidad de Ozonoterapia. No requiere anestesia.

2. Inyección de ozono dentro del disco intervertebral (discolisis percutánea). Se realiza en quirófano bajo sedación y anestesia local, mediante control radiológico. No precisa ingreso hospitalario.

3. Infiltraciones paravertebrales: Inyecciones paravertebrales (de 8 a 12 sesiones) en consulta.


5. BIBLIOGRAFÍA Y CONGRESOS

Iliakis E., Valadakis V., et Al: Rationalization of the Activity of Medical Ozone on Intervertebral Disc. Rivista di Neuroradiologia 14 (Suppl 1):23-30, 2001
 

Leonardi M. : Disc Puncture under Fluoroscopic Guidance. Rivista Italiana di Ossigeno-Ozonoterapia 1: 73-78, 2002

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