The only way to significantly improve the blood flow to the vertebrae and intraosseous receptors is to intraosseously administer medical preparations directly to the spongia of the bones involved. Intraosseous administration of medical preparations is a very well known technique and is nothing but a variation of the intravenous technique. It is widely used for administering large volumes of fluids and blood substitutes, in intraosseous anesthesia and for different radiological diagnostic procedures. Puncture of spongia is mainly done for examination of the bone marrow.

The therapeutic effect of IOBs can be attributed to the following factors:

1)Introduction of the needle into the bone virtually amounts to decompressive trepanation of the cortical layer and this leads to a decrease in the intraosseous pressure which in turn reduces the stimulation of intaosseous receptors.

2)The osteal tissues undergo a process of repair and restoration for 3-6 weeks after the blockade is done. This helps to stimulate the process of regeneration and improves local microcirculation.

3) The introduction of the needle directly into the bone exerts a strong, negative influence on the pathological factors that lead to Osteochodritis of the vertebrae.

4) Adminisration of the medicine directly into the spongia helps us to attain high concentration of it in the bone and thus guarantees maximum effect on the osteoreceptors.

5)Due to the peculiarity of Vertebral blood circulation the medicinal preparations injected directly into it acts on tissues surrounding the Vertebrae as well.

6) Injecting fluid into the bone helps to drain and open up the collateral intraosseous blood vessels thus improving the blood circulation inside the bone. Complications following intraosseous injections are very rare (< 0,5% according to studies). Common complications include Haematomas (subcutaneous, supraosteal, subaponeurosal) which usually occur when the needle is introduced very loosely into the bone and Osteomyelitis which has been seen in patients who have been receiving intraosseous infusions for a long period of time or in cases with weak immunity in whom the needle was kept inside the bone for long time. No study till date has reported Osteomyelitis as a complication of Introsseous blockades. Many researchers have recommended administering a single dose of antibiotics after Intraosseous procedures as a means of preventing complications due to infection. While in the paravertebral method(which is the most frequently used technique for medical purposes) there is a substantial risk of nerve and blood vessel damage, such risks are not present in the intraosseous method.

So the advantages that the IOB has over other methods of blockade with regard to their action on the pathogenetic factors that lead to NPPO are quite obvious.

The method in itself is quite simple and does not require any special training or instruments. First, ordinary layer by layer infiltration anesthesia till the aponeurosis is achieved by using a solution of 0,5% Lidocaine or Trimecaine. Now the intraosseous needle is introduced alongside the intramuscular needle until it is 0,5-1,0 cm within the spongia of the bone. The needle should be located densely inside the bone.

If the needle is placed loosely then fluid is injected or some neighboring section of the same bone is punctured all over again (not very advisable as there is a risk of Haematoma). In such cases it is better to put off the procedure till the next day.

Puncture of the Spongia is done with the intraosseous needle itself. Different modifications of the needle are used for this purpose: Kassirski needle, TSITO needle, Needle used in the biopsy of bone marrow, are a few of them. Sometimes needles used for Spinal cord punctures are also used.

Projections of the bone located superficially can be punctured with an ordinary single use needle. But this method requires a lot of experience as more often than not the needle gets blocked by osteal tissue and its tip bends. We have been using IOB in our clinic for the past 20. During this period about 1000 patients with severe Lumbosacral pain were treated by us with periostal and IO blockades. The outcome of our treatment has proved the high effectiveness of these blockades-over 80%,even in patients with herniation of the intravertebral discs touching 10-12 mm. Periostal and IO blockades have proved to be highly effective in the treatment of Vertebrocardialgias as well.

In such cases the blockades not only decreased the pain in the cardiac region but also improved the contractile ability of the myocardium and significantly decreased Arrhythmia. A striking example of this is one of our patients who had been under observation at the cardiac center for severe arrhythmia before being treated by us. As all methods of conservative treatment had failed in her case she was about to go in for a Pacemaker operation. But after being treated with IO blockades her arrhythmia practically disappeared and she could thus avoid the operation.

During the last 3 years we have started using IO and periostal blockades in patients who have been suffering from Trigeminal neuralgia for longer than 10 years and on whom other methods of treatment have proved ineffective. In 35-40% of these patients pain disappeared all together while in another 35-40% of them pain decreased to less than half of what that they had earlier. IO blockades gives excellent clinical results even in patients with so called central mechanism of Trigeminal neuralgia and Status Trigeminalis.