Treatment of the lumbar disc herniation with intradiscal and intraforaminal injection of oxygen-ozone.
BACKGROUND AND OBJECTIVE
Oxygen-ozone therapy is a minimally invasive treatment for lumbar disk herniation that exploits the biochemical properties of a gas mixture of oxygen and ozone. The purpose of our study was to prospectively evaluate the clinical effectiveness of oxygen-ozone therapy and compared the therapeutic outcome of injection of oxygen-ozone combined steroid with injection of ozone alone at different follow-up period.


MATERIAL AND METHODS
From Aug 2005 to Mar 2009, 172 consecutive adult patients (92 men, 80 women; age range: 23-59 years) with low back pain and radicular pain were included in this study and were randomly assigned to two groups. 90 patients (group A) underwent intradiscal and intraforaminal injection of oxygen-ozone and 82 patients (group B) received the same treatment with additional injection of 1ml of compound betamethasone. Visual analogue scale (VAS) and the Japanese Orthopedic Association's evaluation system for lower back pain syndrome (JOA score) were administered before treatment and at 3 weeks, 6 and 12-month follow-up period to evaluate the clinical results.


RESULTS
Satisfactory clinical outcomes were obtained in both groups. The reduction of VAS score from baseline to the end of the study was 7.68 to 2.17 and 7.49 to 2.23 in group A and group B respectively, and there were remarkable improvements of mean JOA score and recovery rate in every follow-up time in both groups. Furthermore, in 3 weeks follow-up the JOA recovery rate of group B is higher than that of group A, which there was significant different, but there were no significant differences between two groups in 6 and 12 months.


CONCLUSION
In our study, oxygen-ozone nucleolysis provides excellent pain relief in most herniated disc patients who failed to respond to conservative therapy. And there was no significant statistical difference between treatment of injection of oxygen-ozone combined with steroid and ozone only in the 6 and 12 months follow-up. Therefore, O2-O3 seems to play a role in pain relief, and we suggest the administration of the O2-O3 mixture as a first-choice treatment before recourse to surgery or when surgery is not possible and the addition of epidural steroid infiltration is not required.


LEVEL OF EVIDENCE
Level 1-1 (prospective study).