Over the years, infiltrative oxygen-ozone therapy has shown clinical benefits in several musculoskeletal disorders, due to its potential analgesic, anti-inflammatory, antioxidant and immunomodulatory effect. Ultrasonography is a safe, non-invasive imaging, easily available, and has the additional advantage of being real time for imaging and image-guided procedures of the musculoskeletal system. This review explains the numerous promising ways in which ultrasonography can be useful in oxygen-ozone therapeutic practices for musculoskeletal disorders, in order to improve safety and accuracy of treatment.

Background. Plantar fasciitis (PF) is one of the most common causes of heel pain. The use of ESWT is approved in the treatment of chronic PF. The aim of this study was to conduct a retrospective analysis to create models for a pre-treatment evaluation in people with PF, and to assess whether demographic and clinical features could be used to predict medium-term outcomes six months after fESWT. Methods. 183 cases of plantar fasciitis were treated with fESWT. The outcome was NRS variation at three and six months. Age, gender, Likert scale and FAOS were the predictive factors evaluated. Results. A significant improvement in the mean values of NRS and FAOS was observed at the follow up controls. Patients with unfavorable characteristics association (age ≥ 56 years, FAOS < 66.7, Likert scale 3-4) showed higher NRS values, instead patients with favorable characteristics association (age < 56 years, FAOS ≥ 66.7, Likert scale 1-2) showed lower NRS values. Conclusions. The multilevel modeling creates clinical models for a pre-treatment evaluation of patients with PF, predicting a better or worse medium-term after fESWT. The patient presenting a combination of unfavorable characteristics could be informed about a worst therapeutic response, and modification on therapy protocol or association of different therapies could be considered.

Facet joint osteoarthritis is the most prevalent source of facet joint pain and represents a significant cause of low back pain. Oxygen-ozone therapy has been shown to have positive results in acute and chronic spinal degeneration diseases and it could be a safe and efficacious alternative to traditional facet joint conservative treatments. This review article explains the interventional facet joint management with ultrasound-guided oxygen-ozone therapy, providing an anatomy/sonoanatomy overview of lumbar facet joints and summarizing the potential mechanism of action of oxygen-ozone in the treatment of facet joint osteoarthritis, not yet fully understood.

Spinal pain is recognized as the most common cause of disability, work absenteeism and need of healthcare services worldwide. Although many strategies have been developed for conservative treatment of spinal pain, its increasing prevalence diagnosis highlights the need for new treatments. Oxygen-ozone (O 2 –O 3 ) therapy is considered to be an alternative therapy due to its analgesic and anti-inflammatory effects. This retrospective study evaluated the effects of O 2 –O 3 intramuscular paravertebral injections in 76 patients with chronic neck pain or low back pain, in terms of pain and disability reduction, quality of life improvement, and analgesic drug intake. Patients were evaluated before, at the end of the treatment, and at 1, 3 and 6 months after the last treatment, using Numeric Rating Scale, Neck Disability Index or Oswestry Disability Index, and Short Form-12 Health Survey. There were significant beneficial effects of O 2 –O 3 therapy in reducing pain and disability reduction and improving quality of life during the 6-month follow-up period. O 2 –O 3 therapy was associated with a reduction in analgesic drug intake at each assessment. Our results allow us not only to support treatment with O 2 –O 3 intramuscular paravertebral injections as a safe and beneficial treatment for chronic low back pain, but also to consider it as a valuable conservative therapy for patients with chronic neck pain.