A Case of Paradoxical Embolism Causing Anterior Spinal Cord Syndrome and Acute Myocardial Infarction Following the Intradiscal Oxygen-Ozone Therapy
He R, Huang Q, Yan X, Liu Y, et al. Frontiers in Neurology, 2019.
- Study type
- Case report
- People studied
- 1 person
- Population
- 66-year-old woman with lumbar disc herniation at L4/L5 and L5/S1, without hypertension or coronary heart disease, given an intradiscal oxygen-ozone injection
- Published
- 2019, Frontiers in Neurology
- Identifiers
- PMID 30853936, DOI 10.3389/fneur.2019.00137
What the authors reported
During a CT-guided intradiscal oxygen-ozone injection, after 8 ml of gas, the patient developed flaccid paralysis of both legs, then chest pain with ST elevation; coronary angiography found no vascular abnormality. MRI showed a thoracic cord lesion from T2 to T10, and contrast echocardiography a large patent foramen ovale. At nine months she could stand with a cane.
What limits this result
Single case report. The authors judge air embolism through a patent foramen ovale the most likely cause after excluding other causes; the gas itself was not imaged. No ozone concentration is reported, and the abstract and case text give different times for the onset of chest pain.
Harms reported after ozone therapy, and studies of how ozone exposure affects health. One study rarely settles a medical question; our guides weigh each paper against the rest of the evidence.
How the study was done
- Design
- Case report
A Case of Paradoxical Embolism Causing Anterior Spinal Cord Syndrome and Acute Myocardial Infarction Following the Intradiscal Oxygen-Ozone Therapy
- Setting
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China (author affiliation); the injection was given at a local hospital
- Read from
- Read from the full text of the paper. Read on September 29, 2026.
Source: Abstract on PubMed
Study arms
| Group | Participants | What they received |
|---|---|---|
| Single patient | Not reported | Percutaneous intradiscal injection of oxygen-ozone at a local hospital, March 2018 |
Source: Full text on PubMed Central
What it measured
- Onset during the injection
- After 8 ml of oxygen-ozone mixture had been injected, weakness and loss of sensation in both lower limbs
- Neurological examination
- Complete flaccid paralysis of both lower extremities, motor power 0/5 (MRC), absent deep tendon reflexes
- Electrocardiogram
- ST-segment elevation in V1-V6 leads
- Coronary digital subtraction angiogram
- No vascular abnormality detected
However, subsequent coronary digital subtraction angiogram (DSA) did not detect vascular abnormality.
- Spinal MRI, three days after onset
- Hyperintensity in the thoracic cord from T2 to 10 level on T2-weighted images
- Transthoracic echocardiography with saline contrast
- Large patent foramen ovale, with massive microbubbles detected in the left atrium
- Motor power at 1 month
- 2/5 in the right lower limb and 1/5 in the left, with hyperreflexia and abnormal reflexes in both lower limbs
During the follow-up, 1 month later, we observed her clinical improvement with motor power of 2/5 in right lower limb and 1/5 in left lower limb, along with hyperreflexia and abnormal reflexes in the bilateral lower limbs.
- Motor power at nine months
- 4/5 in the right lower extremity and 3/5 in the left
Safety as reported
Anterior spinal cord syndrome and ST-elevation myocardial infarction, which the authors judged most likely caused by air embolism
Source: Full text on PubMed Central
Follow-up
Nine months; recovering from paraplegia and able to stand with a cane
Source: Full text on PubMed Central
Funding and conflicts
Funding: National Natural Science Foundation of China (No. 81400978); Hunan Provincial Natural Science Foundation, China (No. 2018JJ2643)
Source: Full text on PubMed Central
Where we cite this study
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