Ultrasound Guided Erector Spinae Plane Block with Ozone & Corticosteroid for the Management of Discogenic Back Pain: A Case Report

Lumbar fluoroscopic or CT-guided intra-discal ozone injections with or without corticosteroid, have reportedly been a successful back pain-sciatica treatment. Ozone may also enhance the longevity of corticosteroid anti-inflammatory effects. However, growing evidence that the mere act of needle puncturing the intervertebral disc may inadvertently set off an annular degenerative cascade taking several years to manifest, has prompted a search for less invasive yet effective alternatives. Ultrasound Guided (USG) Erector spinae plane (ESPB) blocks may offer a relatively safer, less technically challenging alternative to intra-discal ozone injection by means of diffusing ozone through tissues into the gas-permeable annulus, rather than injecting ozone into the disc itself. ESPB is a relatively new procedure and its use with ozone in DLBP management has not yet been described in the literature.  This paper details the management of a 40-year-old male chef suffering from disabling low back pain and unilateral lower limb radiculopathy using an ESBP with Ozone-corticosteroid, with rapid-sustained pain relief, and restoration of sustained work-ADL function on 6 months follow up.