Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Dec 1:8:17.
doi: 10.14444/1017. eCollection 2014.

Five and ten year follow-up on intradiscal ozone injection for disc herniation

Josip Buric  1 , Luca Rigobello  2 , David Hooper  3
Affiliations

Five and ten year follow-up on intradiscal ozone injection for disc herniation

Josip Buric et al. Int J Spine Surg. .

Abstract

Background: Disc 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.

Methods: One 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.

Results: MRI 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 evidence: We 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 relevance: Intradiscal 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.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Time course of operations following ozone treatment. The blue line represents actual responses from patients contacted. The red line indicates a worst-case scenario where all patients lost to follow-up went on to surgery.
Fig. 2
Fig. 2
MRIs from two patients showing a reduction in the volume of the disc herniation after intradiscal ozone injection.
See this image and copyright information in PMC

References

    1. Choy DS. Percutaneous laser disc decompression. J Clin Laser Med Surg. 1995;13:125–126. - PubMed
    1. Martin BI, Mirza SK, Cornstock BA, Gray DT, Kreuter W, Deyo RA. Are lumbar spine reoperation rates falling with greater use of fusion surgery and new surgical technology. Spine. 2007;32(19):2119–2126. - PubMed
    1. Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical vs non-operative treatment for lumbar disc herniation. The Spine Patients Outcomes Research Trial (SPORT): A randomized trial. JAMA. 2006;296:2441–2450. - PMC - PubMed
    1. Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical vs non-operative treatment for lumbar disc herniation. The Spine Patients Outcomes Research Trial (SPORT): Observational cohort. JAMA. 2006;296:2451–2459. - PMC - PubMed
    1. Atlas SJ, Keller RB, Wu YA, Deyo RA, Singer DE. Long-term outcomes of surgical and non-surgical management of sciatica secondary to a lumbar disc herniation: 10 year results from the Maine lumbar spine study. Spine. 2005;30(8):927–935. - PubMed

LinkOut - more resources