Ozone Therapy in the treatment of disc herniation (Part One)

Low back pain is one of the most common complaints in humans. It is estimated that about 80% of Americans have back problems at least once in their lifetime. In the USA, the annual cost of low back pain is 20-100 billion dollars. This cost is 2-3 times higher than that of caring for heart diseases.

In 90% of cases, back pain goes away within 4 weeks regardless of treatment. The remaining 10% constitute one of the greatest challenges of conventional medical treatment. Most of these patients have either an intervertebral disc prolapse or an unidentified physiopathological cause. Since it was first diagnosed over 70 years ago, disc herniation is considered a major cause of back pain that does not respond to conservative therapy.

All forms of treatment aim at the decompression of nerve roots. This can be achieved by surgery or various interventions from pain medicine.

The different treatment options have caused confusion among clinicians and researchers due to a high percentage of failures:

• Various surgeries: 8–51%
• Epidural steroids: 15–30% with a high recurrence rate.
• Chemonucleolysis with chymopapain: ~20%

To understand the action of ozone in the treatment of disc herniation, it is essential to know the structure of the intervertebral disc. The intervertebral discs are semi-elastic structures located between the vertebral bodies. They absorb the impacts that may come to the spinal column from immediate overloads.

Each disc has a peripheral part (annulus fibrosus) and a central part (nucleus pulposus). As seen from the figure, the annulus fibrosus has collagen fibers arranged in concentric layers surrounding the nucleus pulposus.

The nucleus pulposus has a gelatinous structure and is the real shock absorber between the vertebrae. When put under pressure, it deforms and transmits it in all directions. From the figure, it is seen that the nucleus has more water and proteoglycans which interweave with each other.

Ozone therapy is one of the types of IPM (Interventional Pain Management) that fills the gap between conservative treatment and surgical treatment of low back pain. It has been successfully used in Europe for over 40 years.

Mechanisms of action

• Anti-inflammatory effect: oxidizes inflammation mediators (arachidonic acid, prostaglandins) and regulates pH in the inflamed tissue.
• Hyperoxygenation of the conflict zone disc-root
• Destruction of proteoglycan bridges reduces the water-holding capacity of the nucleus pulposus; this reduces the size of the herniation and decompresses the nerve root.
• Stimulation of fibroblastic activity increases growth factors in the region around the disc herniation.