Effectiveness of intradiscal ozone injections for treating pain following herniated lumbar disc: A systematic review and meta-analysis

Article type: Review Article

Authors: Chang, Min Cheol^a | Choo, Yoo Jin^a | Denis, Isabelle^b | Mares, Christopher^b | Majdalani, Carl^b | Yang, Seoyon^{c; *}

Affiliations: [a] Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Taegu, Korea | [b] Department of Physical Medicine and Rehabilitation, Centre Hospitalier de l’Université de Montréal, Montreal, Canada | [c] Department of Rehabilitation Medicine, School of Medicine, Ewha Woman’s University Seoul Hospital, Seoul, Korea

Correspondence: [*] Corresponding author: Seoyon Yang, Department of Rehabilitation Medicine, School of Medicine, Ewha Woman’s University Seoul Hospital, 260 Gonghang-daero, Gangseo-gu, Seoul 07804, Korea. E-mail: [email protected].

Abstract: BACKGROUND: Low back pain and sciatica caused by herniated lumbar discs (HLDs) are common complaints among patients visiting pain clinics. Among the various therapeutic methods, intradiscal ozone injections have emerged as an effective alternative or additional treatment option for HLDs. OBJECTIVE: This meta-analysis aimed to investigate the effectiveness of intradiscal ozone injections in the treatment of HLDs. METHODS: We searched the PubMed, Embase, Cochrane Library, and Scopus databases for relevant studies published until January 25, 2024. We included studies that investigated the efficacy of intradiscal ozone injections in patients with HLDs. We evaluated the methodological quality of individual studies using the Cochrane Collaboration tool. RESULTS: At ⩾ 6 months after treatment, the therapeutic effect of intradiscal ozone injections in patients with HLDs was greater than that of steroid injections (treatment success rate, 6 months: odds ratio = 3.95, 95% confidence interval [CI] [2.44, 6.39], P< 0.01) or conventional medications (changes in the Visual Analog Scale [VAS], 6 months: standardized mean difference [SMD] = 1.65, 95% CI [1.08, 2.22], P< 0.01; 12 months: SMD = 1.52, 95% CI [0.96, 2.08], P< 0.01) but similar to that of microdiscectomy (changes in VAS, 18 months: SMD =-0.05, 95% CI [-0.67, 0.57], P= 0.87). At < 6 months after treatment, the reduction in the VAS score after intradiscal ozone injections was higher than that after steroid injections (changes in VAS, 1 month: SMD = 2.53, 95% CI [1.84, 3.21], P< 0.01). CONCLUSION: Intradiscal ozone injections may be a useful therapeutic tool in patients with HLDs. Compared with other conventional treatment methods such as steroid injections and oral medications, intradiscal ozone injection has great long-term (⩾ 6 months) effectiveness.

Keywords: Injections, pain management, intervertebral disc displacement, low back pain, pain, meta-analysis

DOI: 10.3233/BMR-240024

Journal: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 5, pp. 1131-1139, 2024