Clinical Effectiveness of Intradiscal Ozone Therapy with or Without Periforaminal Steroid Injection in Lumbar Disc Herniation: Revisiting an Underutilized Treatment.

INTRODUCTION: Lumbar disc herniation (LDH) often causes low back pain and radiculopathy, leading to significant disability. Most of the patients improve with conservative treatment, but some require interventional procedures. Intradiscal ozone therapy is a minimally invasive treatment that reduces inflammation and dehydrates discs, lowering disc volume and decompressing nerve roots. Despite these benefits, its clinical use is limited. This study evaluates the effectiveness of intradiscal ozone therapy, with or without periforaminal steroid injection, in patients with symptomatic LDH. MATERIALS AND METHODS: This retrospective cohort hospital-based observational study included 100 patients with clinically and radiologically confirmed LDH who had persistent symptoms despite conservative therapy. All patients underwent fluoroscopy-guided intradiscal injection of an oxygen-ozone mixture. Patients with significant radicular symptoms also received a periforaminal steroid injection. Clinical outcomes were assessed using the Visual Analog Scale (VAS) for pain and the Oswestry Disability Index (ODI) for functional disability at baseline and at 1-, 3-, and 6-months post-procedure. Treatment outcomes and complications were recorded. RESULTS: Pain and functional status improved during follow-up. VAS and ODI scores consistently decreased from baseline, indicating substantial pain relief and greater functional capacity. Patients treated with both intradiscal ozone therapy and periforaminal steroid injection experienced faster early relief of radicular symptoms than those receiving ozone therapies alone. Both groups maintained improvement at final follow-up. No major procedure-related complications occurred. CONCLUSION: Fluoroscopy-guided intradiscal ozone therapy is a safe, effective, minimally invasive treatment for LDH. Adding a periforaminal steroid injection may speed early relief in patients with pronounced radicular pain. Intradiscal ozone therapy remains valuable yet underused for the management of LDH.