Compressive Ischemic Neuropathies
Tunnel compressive ischemic neuropathy is a pathology of nerve trunk caused by its local irritation, compression and ischemia in anatomically and biochemically adverse conditions of nerve location (V.S.Lobzin, A.F.Rahimdzanov, N.M.Zhulev, 1988). This definition alone makes it clear that compressive ischemic neuropathy (CIN) is a polyetiologic disease. Considering the leading role of nerve trunk ischemia in the pathogenesis of CIN, for improvement of blood circulation, oxygen supply and function of compressed nerves it is advisable to use ozone therapy.
Recommended methods of ozone therapy:
· Intravenous drop-by-drop infusions of ozonated saline solution.
Positive clinical results were received in 95% of cases with ozone therapy as a significant decrease in complaints, normalization of provocative tests, improvement of sensitivity in the zone of innervation of affected nerve. Owing to the considerable decrease or disappearance of night paresthesia of hands after the course of ozone therapy, it comes to normalization of night sleep, improvement of general state, increase in workability. Ozone therapy in the form of ozonated saline drips didn't cause any deterioration of the patients' state, side effects or complications (Yu.P.Potehina, 1997).
The improvement came as a rule after 3-6 procedures. After all, at the end of one course of ozone therapy the inhibition of lipid peroxidation processes and activation of antioxidant activity took place according to the data of biochemiluminescence analysis of blood plasma and determination of lipid peroxidation products.
The achieved results of treatment kept on average for 7 months. So, it is recommended to provide the patients with compressive ischemic neuropathies prophylactic courses of ozone therapy including 5-12 ozonated saline drips every two days, two times per year, in spring and autumn.
Summarizing the investigated and well-known mechanisms of action of ozone, ozone therapy in the form of ozonated saline drips is involved into the pathogenesis of compressive ischemic neuropathies at several stages:
1.Parenteral ozone therapy facilitates an increase in the partial oxygen pressure of arterial blood through the oxygen saturation of both plasma and erythrocyte hemoglobin (R.Chiong et al., 1990), which can induce a decrease in both general and local tissue hypoxia, activation of gas metabolism in the zone of ischemia.
2.Ozone is able to stimulate glucose metabolism in the erythrocytes, formation of 2,3-diphosphoglycerate - substance contributing to the more complete oxygen release by oxyhemoglobin and shift of oxyhemoglobin dissociation curve to the right (O.Rokitansky, 1982). Thus, more oxygen is released to the tissues, particularly affected by ischemia.
3.Owing to the interaction with corpuscle membrane lipids, ozone increases the deformability of the erythrocytes and decreases their aggregation and thus improves fluidity of blood in micro flow bed.
4.The ozonated saline drips improve peripheral blood circulation through the elimination of arteriolar spasm, increasing pulse blood filling and improving venous blood outflow to the limbs. Ozone can facilitate a decrease in arteriolar spasm and opening of non-functional capillaries thus activating microcirculation in the ischemized tissues.
5.Ozone used in therapeutic doses moderately decreases blood coagulation by shifting the values of coagulogram to the bottom level of norm, particularly in cases of initial tendency to hypercoagulation. This can help to decrease or prevent intravascular coagulation of blood, particularly in case of venous stagnation and ischemia. By inducing moderate hypocoagulation in the form of increase of activated recalcification time and activated thromboplastin time, decrease of platelet aggregation and activation of fibrinolysis, ozone is able to prevent thrombosis at the areas of decelerated blood flow and facilitates the lysis of produced small thromboses thus improving the rheological properties of blood.
6.Thanks to the improved blood circulation, particularly in micro flow bed, ozone possibly decreases tissue edema and tissue tension in the canal.
Thus, ozone actively involved into the pathogenesis of compressive ischemic neuropathies stimulates the restoration of affected nerve primarily through the improvement of microcirculation and rheology of blood. Ozone therapy without eliminating the main causes of nerve trunk compression decreases hypoxia and activates oxygen metabolism in the ischemized tissues. Such a pathogenetic action of ozonated isotonic solution is very important for nervous tissue where only aerobic processes can take place.
Ozone used by parenteral route can directly or indirectly influence on some mechanisms of formation of compressive ischemic neuropathies and at the same time break "adverse circles" of pathogenesis as well as optimize oxygen homeostasis in the compressed nerve trunk.