title: Treatment of Contained Herniated Lumbar Discs With Ozone and Corticosteroid: A Pilot Clinical Study.
abstract: OBJECTIVE
  The primary objective of this pilot study was to compare pain and function scores from patients before and after an ozone injection in combination with steroids and bupivacaine to treat herniated discs. A secondary objective was to correct some of the methodological weaknesses of some previously published ozone studies.
  
  
  METHODS
  Fifty patients were enrolled; 1-3 mL of 2 wt% ozone in 98 wt% oxygen was delivered into the nucleus pulposus, and 7-9 mL into the adjacent paravertebral tissues. The oxygen/ozone treatment was followed by a periganglionic injection of corticosteroid and bupivacaine. All patients were evaluated 1 month after the treatment to quantify improvement in pain and function, and to monitor for potential adverse events.
  
  
  RESULTS
  Forty-four patients had intradiscal injections and were included in the analysis. After 1 treatment, 75.0% showed significant improvement in pain based on the visual analog scale (improvement >1.8), 72.7% showed significant improvement in function based on the Oswestry disability index (improvement >15%), and 79.5% showed improvement based on the modified MacNab criteria. There were no adverse events associated with the treatment.
  
  
  CONCLUSIONS
  Patients showed significant improvement in pain and function after receiving ozone injections in combination with steroids and bupivacaine for the treatment of herniated discs. Because of the lack of a control group and short follow-up times, conclusions about the safety and efficacy of ozone injections for the treatment of herniated discs are not warranted. However, the results provide sufficient evidence that the risk and expense of an additional randomized controlled study is merited.
authors.affiliation: Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada. Electronic address: Kieran.Murphy@uhn.on.ca.
authors.forename: Kieran
authors.initials: K
authors.lastname: Murphy
authors.affiliation: A. Cardarelli Hospital, Napoli, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Muto
authors.affiliation: ActiveO, Salt Lake City, Utah, USA.
authors.forename: Jim
authors.initials: J
authors.lastname: Steppan
authors.affiliation: ActiveO, Salt Lake City, Utah, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Meaders
authors.affiliation: ActiveO, Salt Lake City, Utah, USA.
authors.forename: Chett
authors.initials: C
authors.lastname: Boxley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002045:Bupivacaine / Q000008:administration & dosage*; D004185:Disability Evaluation; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007403:Intervertebral Disc / Q000187:drug effects; D007405:Intervertebral Disc Displacement / Q000628:therapy*; D008159:Lumbar Vertebrae / Q000187:drug effects; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000077555:Methylprednisolone Acetate; D008875:Middle Aged; D010126:Ozone / Q000008:administration & dosage*; D010147:Pain Measurement; D010865:Pilot Projects; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D000077555:Methylprednisolone Acetate; D010126:Ozone; D008775:Methylprednisolone; D002045:Bupivacaine
keywords: Clinical study; Corticosteroid; Herniated disc; Lumbar disc; Ozone