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Background and Aims Back pain is a very common pathology in Chronic Pain Units, often induced by lumbar disc herniation. Different therapeutic interventions have been studied, being conservative measures first-line treatment. Oxygen-ozone injections are becoming more common as an alternative therapy but its efficacy in terms of pain relief and functional improvement is uncertain. Even though it is considered a minimally invasive technique, potential complications such as hematoma, local infections or nerve irritation, have been described.
Methods We present a case of a patient who suffered a posterior reversible encephalopathy syndrome (PRES) secondary to a subarachnoid embolism after oxygen-ozone injections, a side effect non-previously reported in the literature.
Results 83-year-old woman, with general arthrosis and chronic back pain secondary to herniated disc, electively submitted to oxygen-ozone intradiscal injection in an outpatient clinic. Immediately after the injection, she suffered a sudden decrease of consciousness and was transferred to our hospital. She presented a Glasgow Score of 8, global aphasia, right oculocephalic deviation, right upper extremity claudication and bilateral babinski sign. An AngioCT scan showed two air bubbles in subarachnoid sulci of the left frontal and parietal lateral convexity with subcutaneous emphysema. She was intubated, transferred to ICU and received two hours of hyperbaric therapy. Magnetic resonance showed probable PRES secondary to oxygen-ozone encephalic embolism. Afterwards, she could be extubated with no neurological sequelae.
Conclusions Oxygen-ozone injections as intradiscal therapies, have multiple associated complications that must be taken into account when assessing risks and benefits. Further studies are needed to evaluate outcomes and associated complications.
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