Five and Ten Year Follow-up on Intradiscal Ozone Injection for Disc Herniation

Abstract

BackgroundDisc herniation is the most common cause for spinal surgery and many clinicians employ epidural steroid injections with limited success. Intradiscal injection of ozone gas has been used as an alternative to epidural steroids and surgical discectomy. Early results are positive but long-term data are limited.MethodsOne hundred and eight patients with confirmed contiguous disc herniation were treated with intradiscal injection of ozone in 2002-2003. One-hundred seven patients were available for telephone follow-up at 5 years. Sixty patients were available for a similar telephone follow-up at ten years. Patients were asked to describe their clinical outcome since the injection. Surgical events were documented. MRI images were reviewed to assess the reduction in disc herniation at six months.ResultsMRI films demonstrated a consistent reduction in the size of the disc herniation. Seventy-nine percent of patients had a reduction in herniation volume and the average reduction was 56%. There were 19 patients that ultimately had surgery and 12 of them occurred in the first six months after injection. One of these 12 was due to surgery at another level. Two surgeries involved an interspinous spacer indicated by stenosis or DDD. All other surgeries were discectomies. Of the patients that avoided surgery 82% were improved at 5 years and 88% were improved at 10 years. Other than subsequent surgeries, no spine-related complications were experienced.Conclusions/Level of EvidenceWe conclude that ozone is safe and effective in approximately 75% of patients with disc herniation and the benefit is maintained through ten years. This is a retrospective review and randomized trials are needed.Clinical RelevanceIntradiscal ozone injection may enable patients to address their pain without multiple epidural injections and surgery. The benefit of ozone is durable and does not preclude future surgical options. The risk reward profile for this treatment is favorable.

The speed of reinfusion affects the vascular system during ozone major autohemotherapy

“…For several decades these properties have prompted its use in orthopedic diseases such as osteoarthritis, arthritis, and herniated discs, [14][15][16] contributing significantly to the reduction in surgical treatment and improving patients' quality of life; moreover, arterial and venous vascular diseases, and metabolic, autoimmune, infectious and neoplastic diseases also benefit from it. 17,18 Ozone induces the repair of tissue damage through the release of several growth factors and by activating the body's own stem cells.…”

Disc Herniation and Knee Arthritis as Chronic Oxidative Stress Diseases: The Therapeutic Role of Oxygen Ozone Therapy

“…Another important analgesic effect may be derived by the induction of antioxidant enzymes resulting in the adaptation to chronic oxidative stress. These novel and surprising aspects have allowed formulating the concept of the ozone-paradox [27,28].…”

“…The herniated fragment has to be smaller than 1/3 of the spinal canal. Patients were enrolled in the study from February 2014 to February 2015. all subjects received one intradiscal injection of oxygen-ozone (following the method reported in Buric et al [28]) and eight major ozonated autohaemotherapy two times a week (150 ml of blood + 150 ml of ozone at a concentration of 20 micrograms/ml of gas according to Borrelli et al) [14]. Before and after the last treatment of MOAT we analyzed in all patients the plasma value of Reactive Oxygen were divided in two groups: group 1 (18 rats) received a single intra articular injection of 0.05 ml of monoiodiacetate (MIA), a well-known inflammatory agent, in the right knee, group 2 (18 rats) received in the same articulation 0.05 ml of ozone at dose of 20 micrograms/ml three times a week for a total of 12 injections.…”

A Comparison of Intradiscal Ozone with Transforaminal Triamcinolone and Bupivacaine to Ozone Therapy alone in the Treatment of Discogenic Sciatica

“…Multiple studies have suggested a low complication rate for this ozone disk nucleolysis, with reported success rates varying from 65 to 80% in different studies. 8 Ozone nucleolysis is being used in multiple countries for over three decades. Leonardi popularized fluoroscopic-guided ozone disk nucleolysis globally.…”

“…Leonardi popularized fluoroscopic-guided ozone disk nucleolysis globally. 8,9 Though ozone is toxic in high concentrations, it is applied by mixing with oxygen at nontoxic concentrations. The concentration range of ozone for clinical application in humans is 1 to 40 μg per mL of oxygen.…”