Effectiveness of ultrasonography-guided periforaminal oxygen-ozone therapy in chronic low back pain.

Background/aim: Treatment of chronic low back pain (LBP) includes various minimally invasive image-guided interventional techniques. The aim of this study, which was planned based on the idea that periforaminal oxygen-ozone (O2-O3) gas application with ultrasonography (USG) could be an alternative treatment option, was to compare the therapeutic efficacy of USG-guided periforaminal ozone infiltration (PFOI) or transforaminal epidural steroid injection (TFESI) in patients with chronic radicular LBP on pain, disability, and quality of life (QoL).

Materials and methods: A total of 50 patients were randomly divided into 2 groups of 25 patients each underwent PFOI by USG or TFESI via fluoroscopy. Pain intensity was assessed with visual analogue score (VAS), disability with Oswestry disability index (ODI), and QoL with short form-36 (SF-36), before treatment, at the 2nd week, 1st month, and 2nd month, after treatment.

Results: Intra-group comparisons showed significant improvements in LBP VAS, radicular pain VAS, and ODI after treatment for both groups. The reduction in LBP VAS was found to be higher in the PFOI group at week 2 (p = 0.010) and month 1 (p = 0.037), and the improvement in ODI scores was significantly better in the PFOI group at week 2 (p = 0.017) compared to the TFESI group.

Conclusion: Our findings have shown that PFOI and TFESI have positive effects on chronic radicular LBP, disability, and QoL parameters. Since ultrasound-guided O2-O3 injections were found to be more effective than epidural steroid injections, particularly in the early period, it was suggested that O2-O3 therapy may be considered in the preoperative treatment algorithm of patients with chronic radicular LBP.