Ozone Disc Nucleolysis for Cervical Intervertebral Disc Herniation: A Systematic Review and Meta-Analysis

Abstract

Cervical intervertebral disc herniation is a common condition and most often presents as neck or upper limb pain causing varying levels of disability and dysfunction. Percutaneous injection of ozone into the intradiscal space is a novel and minimally invasive technique for managing this condition and can be an effective alternative to surgical management. A literature search was done using the keywords ozone disc nucleolysis of cervical intervertebral lesions, and five studies were selected based on the inclusion and exclusion criteria. Meta-analysis was performed to determine safety, effectiveness, and symptomatic relief (determined based on the visual analog scale (VAS)) with the publication bias being removed. Subjects treated with ozone therapy showed significant reduction (p < 0.0001) in VAS score as compared to baseline VAS score with a standardized mean difference of 2.78 (95% CI = 1.48 to 4.07; Z value = 4.20). Ozone nucleolysis is a minimally invasive, relatively safe, and optimally effective treatment option for reducing the pain related to cervical disc. Intradiscal ozone therapy can be considered an alternative treatment modality, and well-designed, randomized clinical trials are required to confirm the long-term superiority of ozone therapy against other treatment modalities available for cervical disc herniation.

Keywords: cervical disc herniation; cervical radiculopathy; chemonucleolysis; intradiscal injection; oxygen-ozone mixture.

Figure 1. PRISMA flowchart of the study

PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-analysis

Figure 2. Forest plot showing the comparison of VAS score before and six months after ozone therapy

p ≤ 0.05 is considered as significant

Figure 3. Funnel plot for the assessment of publication bias

SE: Standard error; SMD: standardized mean difference