title: Intraforaminal ozone therapy and particular side effects: preliminary results and early warning.
abstract: BACKGROUND
  The term "low back pain syndrome" represents a complex nosological entity. The therapeutic approach is often only symptomatic and not etiologic.
  
  
  METHODS
  Since 2013, 186 patients (97 males and 89 females, mean age 59.8 years) have undergone microsurgery for lumbar disc hernia or lumbar segmental stenosis. Among these patients, 23 had been previously treated with ozone therapy by the intraforaminal approach and 28 by intraforaminal steroid injections in other hospitals between 12 and 24 months before our clinical evaluation. These patients received 16 applications in an 8-week period (standard therapy).
  
  
  RESULTS
  During the surgery, many hard adhesions between the soft tissues and bony structures were unexpectedly discovered. In particular, it was noted that the root contracted and had firm adhesions to the dural sac and/or fragmented disc, which were difficult to resolve. These specific pathological patterns were observed only in the patients who received ozone injections by the intraforaminal approach. We did not find any pathological abnormalities in the patients who did not receive any injections or who received intraforaminal steroid injections. Thus, we could exclude that the tissue damage was due to the mechanical action of the needle.
  
  
  CONCLUSIONS
  It is important to assert that ozone therapy procedures can be associated with several major complications. Therefore, performing a revision of the guidelines and protocols for ozone therapy application is indispensable.
authors: Orthopaedic and Traumatology Department, Chieti and Vertebral Surgery Department, "G. d'Annunzio" University, Vestini Street, ASL 2 Lanciano Vasto, Chieti, Italy. danielevannimd@libero.it.
authors: Daniele
authors: D
authors: Vanni
authors: Operative Unit of Neurosurgery, San Salvatore Hospital, L'Aquila University, L'Aquila, Italy.
authors: Renato
authors: R
authors: Galzio
authors: Vertebral Surgery Department, ASL 2 Lanciano Vasto, Chieti, Italy.
authors: Anna
authors: A
authors: Kazakova
authors: Orthopaedic and Traumatology Department, Chieti and Vertebral Surgery Department, "G. d'Annunzio" University, Vestini Street, ASL 2 Lanciano Vasto, Chieti, Italy.
authors: Andrea
authors: A
authors: Pantalone
authors: Department of Diagnostic Imaging, Floraspe Renzetti Hospital, Lanciano, Italy.
authors: Antonio
authors: A
authors: Sparvieri
authors: Orthopaedic and Traumatology Department, Chieti and Vertebral Surgery Department, "G. d'Annunzio" University, Vestini Street, ASL 2 Lanciano Vasto, Chieti, Italy.
authors: Vincenzo
authors: V
authors: Salini
authors: Vertebral Surgery Department, ASL 2 Lanciano Vasto, Chieti, Italy.
authors: Vincenzo
authors: V
authors: Magliani
mesh_terms: D004388:Dura Mater / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D007405:Intervertebral Disc Displacement / Q000601:surgery; D017116:Low Back Pain / Q000628:therapy*; D008161:Lumbosacral Region / Q000601:surgery; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D016877:Oxidants / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D010126:Ozone / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D013130:Spinal Stenosis / Q000601:surgery; D013256:Steroids / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D016877:Oxidants; D013256:Steroids; D010126:Ozone
keywords: Low back pain; Ozone therapy; Side effects; Transforaminal approach; Warning