The Use of Medical Ozone in Chronic Intervertebral Disc Degeneration Can Be an Etiological and Conservative Treatment

Abstract

Degeneration of the intervertebral disc is one of the most frequent causes of lumbar pain, and it puts an extreme strain on worldwide healthcare systems. Finding a solution for this disease is an important challenge as current surgical and conservative treatments fail to bring a short-term or long-term solution to the problem. Medical ozone has yielded excellent results in intervertebral disc pathology. When it comes to extruded disc herniation, ozone is the only etiological treatment because it stimulates the immune system to absorb the herniated portion of the nucleus pulposus, thus resolving discal extrusion. This work aims to examine the biomolecular mechanisms that lead to intervertebral disc degeneration while highlighting the significance of oxidative stress and chronic inflammation. Considering that ozone is a regulator of oxidative stress and, therefore, of inflammation, we assert that medical ozone could modulate this process and obtain inflammatory stage macrophages (M1) to switch to the repair phase (M2). Consequently, the ozone would be a therapeutic resource that would work on the etiology of the disease as an epigenetic regulator that would help repair the intervertebral space.

The Emerging Roles of Nanocarrier Drug Delivery System in Treatment of Intervertebral Disc Degeneration-Current Knowledge, Hot Spots, Challenges and Future Perspectives

“… 46–48 Surgical treatment includes minimally invasive surgery and open surgery. Percutaneous enzymatic or laser nucleolysis, 49 ozone nucleolysis, 50 microendoscopic discectomy (MED), 51 percutaneous endoscopic lumbar discectomy (PELD) and percutaneous endoscopic interlaminar discectomy (PEID), 52 the unilateral biportal endoscopic (UBE), 53 lumbar interbody fusion, 54–56 lumbar artificial disc replacement (ARD) 57 were reported to be effective in treatment of LDH ( Figure 2 ).

Figure 2 Diagnostic methods and current treatments of LDH.

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“…Physical therapy, exercise and change of health style, medicine, etc were proven to be useful. [46][47][48] 49 ozone nucleolysis, 50 microendoscopic discectomy (MED), 51 percutaneous endoscopic lumbar discectomy (PELD) and percutaneous endoscopic interlaminar discectomy (PEID), 52 the unilateral biportal endoscopic (UBE), 53 lumbar interbody fusion, [54][55][56] lumbar artificial disc replacement (ARD) 57 were reported to be effective in treatment of LDH (Figure 2).…”

Efficacy of Medical Ozone as an Adjuvant Treatment in Dogs with Intervertebral Disc Protusions—A Retrospective Study

“…This oxidative stress induces inflammation, leading to nucleus pulposus cell nutritional metabolism disorders, apoptosis, decline of cell number, senescence, and autophagy [4]. The intervertebral disc is invaded by granulation tissue with blood vessels that bring cells from the immune system that release inflammatory mediators, generating even more oxidative stress and reactive oxygen species (ROS), promoting a vicious cycle [5,6].…”

“…Ozone modulates oxidative stress through the activation of the Nuclear Factor Erythroid 2-Related Factor 2 (Nrf2) pathway in cells [18][19][20] and then induces the synthesis of cytoprotective proteins, which favors cell survival and improves the oxidative stress in the intervertebral disc degeneration [5,20]. Nrf2 appears to play an important role in the intracellular signaling pathways of inflammation.…”

“…Clinical studies in human medicine have demonstrated its efficacy in the oxidation of metabolites and pain mediators, muscle relaxation, enhancing local microcirculation with a reduction in venous stasis with the consequent reabsorption of spinal edema and improved mobility, reduction in disc volume by oxidation of proteoglycans, and reduction in root inflammation [5,[25][26][27][28][29][30][31].…”