What Is Medical Ozone Therapy For the Spine?

Ozone spine injection is an investigational procedure that has been examined in experimental research trials for the treatment of chronic back pain associated with spinal disc herniation or other similar structural spine problems. It's a controversial treatment that is not approved in the United States. Studies have begun to document the pros and cons of this interventional therapy.

A doctor talking to his patient in a hospital room
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What Is Ozone Therapy?

Medical ozone treatment is a process utilizing oxygen gas in its unstable O3 form, rather than its more stable O2 form for the treatment of medical conditions. (O2 is the form of the oxygen in the air we breathe.)

It is not standard therapy for any medical use, but it has been studied for a wide variety of conditions, including the management and prevention of dental cavities and peripheral vascular disease.

Research experiments have included a variety of methods for medical ozone administration. It has been injected as a gas, applied topically as a gel, and delivered via a gas bath. The technique used must follow the parameters set by each individual study protocol.

The mechanism by which medical ozone therapy may work for various ailments isn't completely understood. In the context of back pain, researchers suggest that O3 molecules produce a chemical reaction that may reduce pain and inflammation and induce degeneration of pain-inducing spine or disc protrusions.

Purpose of the Procedure

Chronic back pain due to spine (backbone) issues is managed using a number of approaches, such as physical therapy, oral medications, and local injections—including nerve blocks and steroids. Surgery is a treatment option as well, although it doesn't always yield good outcomes and may entail revision spine surgery.

Pain-inducing spine problems, which tend to be more common among people over 65, tend to limit physical activity. Often, with these spine conditions, the spinal bones or the cartilaginous discs in between the spinal vertebrae compress the spinal nerves and other structures near the spine, causing pain.

In the treatment of chronic back pain, ozone injection has been studied in the setting of herniated disks, spinal stenosis (narrowing of the spine around the spinal cord), and failed back surgery syndrome.

In research, the procedure is used as an adjunct to other back pain treatments, such as steroid or anesthetic injections.

Results of a 10-year follow-up study of patients who were treated with experimental ozone injection for disc herniation with chronic back pain suggested the procedure was safe and helped them avoid surgery and injections.

Risks and Contraindications

While a few studies have suggested ozone spine injection is, for the most part, safe, there are concerns regarding adverse events and inconsistency regarding the injection techniques.

The procedure may cause complications, including spine infections, septicemia (dangerous infection in the blood), and abscesses of the spine.

It has also been associated with rare side effects, such as heart damage and pulmonary embolism (PE).

Regulation

While it is not available to patients outside a research setting, several companies are working on the development and manufacturing of this treatment and studying its effects.

A number of international studies are in progress evaluating the effects of spinal ozone injection, and the outcomes are being reported in scientific research journals. It has been proposed as a possible option when established treatments, especially steroid injections, are contraindicated.

There are some controversies regarding this treatment, and the Food and Drug Administration (FDA) has stated that "Ozone is a toxic gas with no known useful medical application in specific, adjunctive, or preventive therapy."

The Procedure

In a research trial using ozone therapy for back pain, the details of the procedure would be guided by the study protocol. This includes criteria for participation, pre-testing, the actual injection technique, and the follow-up measures.

The surgical intervention is performed in a sterile environment, such as an operating room or a procedural suite. Anesthesia sedation and surgical monitoring are required.

Participants are positioned in a fetal position so the surgeon can easily access the spine. The skin must be cleaned with antiseptic immediately prior to the procedure.

The oxygen gas, which is obtained from the supplier ahead of time, is inserted through the skin with a needle and released near the spine in the area of pain. The injection is done with the guidance of real-time imaging, such as computerized tomography. While a few different approaches may be used for injection (per the study guidelines), the most common involves injecting the gas directly into the cartilaginous disk.

During and immediately after the procedure, the surgical team uses imaging techniques to observe the gas as it travels in and around the region of the needle placement.

If you are participating in an ozone treatment research trial, you will be required to have an overnight hospital stay after the surgery. You should have periodic neurology examinations to check on your spine and spinal nerve function, as well as close medical monitoring so that complications, such as infections, can be caught as early as possible.

Recovery and Follow-Up

After treatment and discharge from the hospital, reports suggest participants in the experimental studies generally did not experience frequent complications. They were permitted to resume activities, such as going back to work or to physical therapy, after one week. 

It is not completely clear how long it takes for ozone therapy for the spine to be effective. In fact, it's important to note that back pain can resolve over time due to issues like weight changes and modified physical activity. So experts are not sure whether reported positive outcomes are a result of treatment or are due to spontaneous improvement of back pain.

A Word From Verywell

In the U.S., ozone injections are not an approved therapeutic approach for treating back pain. Nevertheless, there are a number of international studies examining the potential of this treatment and there are companies working on studying and producing it. The results and the theory behind the treatment are interesting, but leave some questions unanswered.

If you are suffering from chronic back pain, it's important that you seek medical help and work with your doctor to find the best treatment to relieve your symptoms and improve your quality of life. If you and your doctor agree you should seek experimental treatment, learn as much as you can about the risks associated with the research before you agree to participate.

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