All CT-guided interventions were performed at our out-patient clinic by a single interventional radiologist with a 25 years’ experience in spine disease and treatments.
Patient was placed in the prone position, with a support under the belly in order to prevent excessive back lordosis. Low-dose CT scan of the lumbar region was performed.
Following the conclusion of procedural planning, sterile disinfection of the lumbar region was obtained. Local anaesthesia was routinely not performed.
The LFSC was accessed with a 22G Chiba needle, via a transforaminal approach for foraminal cysts, and ipsilateral or contralateral translaminar approach for medially placed lesions.
Additional low dose CT scans were performed to guide needle positioning until the cyst was entered; aspiration of the cyst was then performed followed by injection of 1-2 mL of gas mixture (2% O3, 98% O2). Final CT scan was then performed to confirm cyst rupture and gas leakage in the epidural space and facet joint (Figure 1 and 2).
When a transforaminal access was used, additional administration of 8 mL of ozone gas mixture and 2 mL of corticosteroid/local anaesthetic was performed after withdrawal of the needle into the foraminal space.
Patients were then discharged after a brief observation interval of 2 hours and referred for follow-up assessment.