Introduction:
Spinal discs are rubbery structures between each vertebrae of the spinal column. They act as shock absorbers and allow for spinal movement. Unfortunately, excessive loads can injure these discs and cause the inner core jelly to spill out and “herniate”. A herniated disc can cause severe inflammation and compression of the lumbar nerves leading to back and leg pain (aka “Sciatica”), muscles spasms and at times weakness and numbness of the leg. The disc herniation can sometimes resolve with conservative treatments such as physical therapy, but often more aggressive treatments are necessary.
Over the last 25 years, Ozone injections into the disc have been used in Europe to safely and effectively treat herniated discs. Ozone is a gas with three oxygen molecules. When injected into a herniated disc, it shrinks the herniation, decreases inflammation and stimulates specialized immune cells known as macrophages to eat up the spilled disc material. A metanalysis published in 2010 that reviewed 12 large studies and 8,000 patients demonstrated that ozone injections were successful at reducing or eliminating the pain and improving function in ~ 70-80% of patients. Recent studies have shown that ozone is as good as surgery at treating herniated discs, with many other benefits.
Study 1 – Ozone Injection vs Disc Surgery
In 2005, Dr. Paradiso from Italy published the results of his study comparing ozone disc injections to surgery in patients with a herniated lumbar disc. For 3 years, he followed the outcomes 150 patients in each group. All patients had chronic back and leg pain and many had leg numbness and weakness. During the study, about 80 – 90% of the patients in both groups experienced significant pain relief. More than 80% of patients from both treatment groups had complete resolution of their leg numbness and weakness. On MRI and CT scan, 80% of the ozone patients had a significant resolution of the disc herniation during the 3 years. Dr. Paradiso concluded that ozone injection was as good as surgery for the treatment of pain and mild neurologic deficits from a herniated disc.
Study 2- Ozone Injection vs Disc Surgery
In 2022, doctors from Greece and Italy published the results of their randomized control trial comparing ozone disc injections vs microscopic disc surgery (microdiscectomy). 43 patients with chronic back and leg pain and MRI evidence disc herniation were randomized to either ozone injection or surgery. More than half of these patients had severe back and leg pain for greater than 6 months, and all patients failed to improve with conservative care.
During the 6 month observation period, 71% of the of the subjects in the ozone group had successful outcomes and were able to avoid spine surgery. Both groups showed rapid improvement in their back and leg pain that was maintained during the 6 months (average pain level dropped from 7/10 to 3/10 in the 1st month). They also had a significant improvement in overall function and quality of life (see graphs below). There were no difference in outcome measures nor any complications in either group. The authors concluded that ozone injections are “non-inferior” to surgery and recommended ozone as the first-line treatment for a herniated lumbar disc.
Conclusion
Ozone injection into the spinal disc is a safe and effective treatment for herniated discs that cause back and leg pain. Ozone is a great alternative to surgery with several advantages: much shorter procedure and recovery time, no need for general anesthesia and no need for narcotic pain medications. According to the literature, spinal disc surgery often requires several days of a hospital stay and has a complication rate of 3-6% of the time. Ozone injection does not require any hospitalization and the complication rate is less than 0.1%. Ozone is also less expensive than surgery and does not require any cutting, thus the natural health of the muscles and bones is preserved.
References:
- Steppan, Jim, et al. “A metaanalysis of the effectiveness and safety of ozone treatments for herniated lumbar discs.” Journal of vascular and interventional radiology 21.4 (2010): 534-548.
- Paradise, Roberto, and A. Alexandre. “The different outcomes of patients with disc herniation treated either by microdiscectomy, or by intradiscal ozone injection.” Advanced Peripheral Nerve Surgery and Minimal Invasive Spinal Surgery. Springer Vienna,
2005. - Kelekis, Alexis, et al. “Intradiscal oxygen-ozone chemonucleolysis versus microdiscectomy for lumbar disc herniation radiculopathy: a non–inferiority randomized control trial.” The spine journal 22.6 (2022): 895-909.
