Oxygen-ozone discolysis is a minimally invasive procedure used in the treatment of certain disc conditions of the spine, particularly contained disc herniations or disc protrusions responsible for radicular pain. The technique consists of injecting a medical mixture of oxygen and ozone into the intervertebral disc and, in some cases, also into the periradicular space, near the irritated or compressed nerve root.
The goal of the treatment is to reduce the volume of the herniated disc material, decrease local inflammation and help reduce the compression on the nerve root. It is a conservative, percutaneous technique that can represent an intermediate option between medication/physical therapy and traditional surgery.
Indications
Oxygen-ozone discolysis is indicated mainly in patients with lumbar or cervical disc herniation causing disc-nerve root conflict, and when painful symptoms persist despite conservative therapies.
The symptoms most frequently treated are lumbosciatica, lumbocruralgia, pain radiating to the lower limb, tingling, burning or altered sensation due to irritation of a nerve root.
The technique may be considered when there are no significant or progressive neurological deficits and when the imaging findings are consistent with a disc compression treatable with a minimally invasive approach.
Not all types of herniation are suitable for this procedure. Chronic herniations, small protrusions, calcified herniations or herniations associated with severe spinal canal stenosis may require different treatments, including surgery.
Mechanism of action
The oxygen-ozone mixture acts through several mechanisms. Within the intervertebral disc, ozone promotes partial dehydration of the nucleus pulposus, leading to a reduction in the volume of the disc and the herniated component. This can help decrease the pressure exerted on the nerve root.
In addition to its mechanical effect, ozone also has an anti-inflammatory action. The reduction of inflammatory mediators can lead to an improvement in radicular pain, which is often related not only to mechanical compression but also to chemical irritation of the nerve root.
The overall effect is therefore twofold: reduced disc pressure and reduced local inflammation.
How the procedure is performed
The procedure is performed in a sterile environment, generally in an operating room or a dedicated radiology suite, with the patient positioned prone for the lumbar segment, or supine for the cervical segment.
After thorough skin disinfection and administration of local anesthesia, a guide needle is introduced through the skin until it reaches the affected intervertebral disc. The correct positioning of the needle is verified using radiological, fluoroscopic or CT guidance, to ensure precision and safety.
Once the disc is reached, a controlled amount of medical-grade oxygen-ozone mixture is injected. Depending on the clinical picture, a periradicular or epidural infiltration with the same mixture may also be performed, sometimes combined with anti-inflammatory medication or local anesthetics, according to the protocol used by the specialist.
The procedure generally has a short duration and does not require surgical incisions.
Advantages of the technique
One of the main advantages of oxygen-ozone discolysis is its minimal invasiveness. Access is achieved through a needle, without surgical cuts, without removal of bone structures and without direct manipulation of the nerve roots.
This results in very limited tissue trauma, low blood loss, generally mild post-procedural pain and faster recovery times compared with traditional surgery.
The procedure can be performed on an outpatient or day-surgery basis, with observation for a few hours after treatment. In most cases, the patient can return home on the same day.
A further advantage is the possibility of repeating the treatment in selected cases, if the specialist considers it appropriate.
Limitations of the procedure
Oxygen-ozone discolysis does not replace surgery in cases involving significant neurological deficits, progressive loss of strength, cauda equina syndrome, severe stenosis or extruded and migrated herniations causing significant compression of the nerve structures.
The outcome depends greatly on correct patient selection. In suitable cases, the treatment can lead to a significant reduction in pain and a functional improvement. In cases that are not adequately selected, on the other hand, the benefit may be partial or absent.
It is important to point out that improvement is not always immediate. In some patients pain may decrease in the following days, while in others the benefit appears gradually over a few weeks.
Possible complications
Oxygen-ozone discolysis is generally considered a safe procedure, but, like any invasive treatment, it can involve possible complications.
Among the most common effects, transient pain at the injection site, mild temporary worsening of radicular symptoms, a feeling of low back discomfort or local stiffness may occur.
Rarer complications include disc infection, bleeding, irritation or injury to the nerve root, vagal or allergic reactions, or complications related to needle placement. Performing the procedure under radiological guidance and in sterile conditions significantly reduces these risks.
Course after treatment
After the procedure, the patient is observed for a short period and then discharged with specific instructions. In the first 24-48 hours, relative rest is recommended, avoiding exertion, lifting weights, sports activity and sudden movements of the spine.
The resumption of normal activities occurs gradually. Light walking can be allowed early on, while return to work depends on the type of activity performed and the clinical response to treatment.
After the initial phase, it is often recommended to add a rehabilitation program aimed at strengthening the abdominal and paravertebral muscles, improving posture and preventing recurrence.
Treatment goal
The goal of oxygen-ozone discolysis is to reduce radicular pain, decrease local inflammation and help reduce the pressure exerted by the disc on the nerve root.
When correctly indicated, this technique can represent a valid minimally invasive option for the treatment of pain due to disc herniation or protrusion, in many cases allowing an improvement in symptoms and a faster return to daily activities while avoiding surgery.
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