Review of intervertebral hernia disease treatment methodologies: Key emphasis on the oxygen-ozone therapy as a method with multifactorial influence
More details
Hide details
Department of Physical and Rehabilitation Medicine of National Pirogov Memorial Medical University, University Clinic of National Pirogov Memorial Medical University, Vinnytsya, Ukraine
Berkshire Medical Center, Pittsfield, MA, USA
Department of Physical and Rehabilitation Medicine of National Pirogov Memorial Medical University, Ukraine
Scientific and Research Institute of Invalid Rehabilitation (Educational, Scientific Treatment Complex) of National Pirogov Memorial Medical University, Vinnytsya, Ukraine
Department of Internal Medicine of National Pirogov Memorial Medical University, Ukraine
University Clinic of National Pirogov Memorial Medical University, Vinnytsya, Ukraine
Submission date: 2021-05-30
Final revision date: 2021-11-28
Acceptance date: 2021-11-29
Online publication date: 2022-05-20
Corresponding author
Iryna V Baranova   

Department of Physical and Rehabilitation Medicine of National Pirogov Memorial Medical University, University Clinic of National Pirogov Memorial Medical University, Vinnytsya, Ukraine.
Pol. Ann. Med. 2022;29(2):267-273
Low back pain is one of the most common causes of short-term, and sometimes long-term, disability in the population younger than 45 years old. Approximately 60% to 80% of the population in developed countries experience back pain in various locations (neck, mid and lower back) at least once in their lifetime. Guidelines regarding back pain treatment are undergoing constant modifications and improvements. The relevance of dorsalgia as a significant medical problem and its management is shown by the increased number of recently published papers, which has tripled in the past several years (from 22% to 65%).

To analyze the most critical risk factors of the degenerative intervertebral disk disease, and to review the effectiveness of invasive and noninvasive methods of treatment of the lower back pain syndrome.

Material and methods:
Recently published papers focusing on invasive and noninvasive treatments of low back pain syndrome.

Results and discussion:
Surgical intervention as a single method of back pain treatment is indicated in a small number of cases. The risk of repeated surgeries for intravertebral disk herniation should be considered before any surgical intervention. A wide variety of treatment options allows to choose the most effective approach based on individual needs.

Conservative, noninvasive approach has shown to be an effective alternative for lower back pain and radiculopathy treatment. It has been determined that ozone therapy is an appropriate, relevant, and affordable treatment method for patients with vertebral degenerative changes and intravertebral disk diseases.

We thank our colleagus from National Pirogov Memorial Medical University (Vinnytsya, Ukraine) for help in collection materials during preparing the manuscript.
This research was not sponsored by any foundations or organizations.
Authors declare no conflict of interest.
Duenas M, Ojeda B, Salazar A, et al. A review of chronic pain impact on patients, their social environment and the health care system. J Pain Res. 2016;9:457–467.
Dinakar P, Stillman AM. Pathogenesis of Pain. Semin Pediatr Neurol. 2016;23(3):201–208.
Vivekananda SP, Garampalli A, Patil SN. Ozone nucleolysis in lumbar intervertebral disc herniation: non-randomized prospective analysis. J Evol Med Dent Sci. 2015;4(37):6456–6466.
Oros MM, Fister NI. Diagnosis and treatment of back pain in the practice of family doctor [in Ukrainian]. J Fam Med. 2020;22(491):36–40.
Amin RM, Andrade NS, Neuman BJ. Lumbar Disc Herniation. Curr Rev Musculoskelet Med. 2017;10(4):507–516.
Gugliotta M, Costa BR, Dabis E, et al. Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study. BMJ Open. 2016:e012938.
Atlas SJ, Deyo RA, Keller RB, et al. The Maine lumbar spine study part II: 1-year outcomes of surgical and non-surgical management of sciatica. Spine J. 1996;21(15):1777–1786.
Tymecka-Woszczerowicz A, Wrona W, Kowalski PM, Hermanowski T. Indirect costs of back pain – Review. Pol Ann Med. 2015;22(2):143–148.
Ademi Z, Gloy V, Glinz D, et al. Cost-effectiveness of primarily surgical versus primarily conservative treatment of acute and subacute radiculopathies due to intervertebral disc herniation from the Swiss perspective. Swiss Med Wkly. 2016;146:w14382.
Wong J, Cote P, Sutton DA, et al. Clinical practice guidelines for the noninvasive management of low back pain: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur J Pain. 2017;21(2):201–216.
Hegarty D, Shorten G. Multivariate prognostic modeling of persistent pain following lumbar discectomy. Pain Physician. 2012;15(5):421–434.
Kokina MS, Filatova EG. Analysis of reasons for failed surgery treatment in patients with back pain [in Russian]. Neurol Neuropsy Psychosom J. 2011;3(3):30–34.
Oba H, Takahashi J, Tsutsumimoto T, et al. Predictors of improvement in low back pain after lumbar decompression surgery: prospective study of 140 patients. J Orthop Sci. 2017;22(4):641–646.
Tu Z, Li YW, Wang B, et al. Clinical outcome of full-endoscopic interlaminar discectomy for single-level lumbar disc herniation: a minimum of 5-year follow-up. Pain Physician. 2017;20(3):425–430.
Huang W, Han Z, Liu J, Yu L, Yu X. Risk factors for recurrent lumbar disc herniation. Medicine J (Baltimore). 2016;95(2):1–10.
Hayes A, Tan EJ, Killedar A, et al. Socioeconomic inequalities in obesity: modelling future trends in Australia. BMJ Open. 2019;9:1–8. bmjopen-2018-026525.
Belykh E, Krutko AV, Baykov ES, et al. Preoperative estimation of disc herniation recurrence after microdiscectomy: predictive value of a multivariate model based on radiographic parameters. Spine J. 2017;17(3):390–400.
Wilson CA, Roffey DM, Chow D, et al. A systematic review of preoperative predictors for postoperative clinical outcomes following lumbar discectomy. Spine J. 2016;16(11):1413–1422.
Murphy ME, Hakim JS, Kerezoudis P, et al. Micro vs. macrodiscectomy: does use of the microscope reduce complication rates? Clin Neurol Neurosurg. 2017;152:28–33.
Tschugg A, Lener S, Hartmann S, et al. Preoperative sport improves the outcome of lumbar disc surgery: a prospective monocentric cohort study. Neurosurg Rev. 2017;40(4):597–604.
Weinstein JN, Lurie JD, Tosteson TD, et al. Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes. Research Trial (SPORT) observational cohort. JAMA. 2006;296:2451–2459.
Shin JS, Lee AJ, Lee AYJ, et al. Long-term course of alternative and investigated therapy for lumbar disc herniatons and risk factors for surgery. Spine J. 2016;41(6):955–963.
Artus M, VanderWindt D, Jordan KP, et al. The clinical course of low back pain: a meta-analysis comparing outcomes in randomised clinical trials (RCTs) and observational studies. BMC Musculoskelet Disord. 2014;15:68–75.
Ackerman WE, Ahmad M. The efficacy of lumbar epidural steroid injections in patients with lumbar disc herniations. Int Anesth Res Soc. 2007;104(5):1217–1222.
Buric J, Molino LR. Ozone chemonucleolysis in non-contained lumbar disc herniations: a pilot study with 12 months follow-up. Acta Neurochir Suppl. 2005;92:93–97.
Korhonen T, Karppinen J, Malmivaara A, et al. Efficacy of infliximab for disc herniation-induced sciatica: one-year follow-up. Spine J. 2004;29(19):2115–2119.
Morselli A, Zuccarini F, Scarpa I, Imperiale C, Guzzo F. Ultrasound Guidance in Paravertebral Injections of Oxygen-Ozone: Treatment of Low Back Pain. J Pain Relief. 2015;4:220–228.
Thackeray A, Fritz J, Lurie J, et al. Nonsurgical treatment choices by individuals with lumbar intervertebral disc herniation in the United States: associations with long-term outcomes. Am J Phys Med Rehab. 2016;96:1–8.
Ucar D, Uçar S, Çaçan MA, et al. Retrospective observational study of intramuscular oxygen-ozone therapy for the treatment of neck pain: cervical paravertebral injection. Med Gas Res. 2020;10:170–173.
Yao Y, Liu H, Zhang H, et al. Risk factors for recurrent herniation after percutaneous endoscopic lumbar discectomy. World Neurosurg. 2017;100:1–6.
Zhong M, Liu JT, Jiang H, et al. Incidence of spontaneous resorption of lumbar disc herniation: a meta-analysis. Pain Physician. 2017;6:45–52.
Cohen SP, Wenzell D, Hurley RW, et al. A double-blind, placebo-controlled, dose response pilot study evaluating intradiscal etanercept in patients with chronic discogenic low back pain or lumbosacral radiculopathy. Anesthes. 2007;107(1):99–105.
Isner-Horobeti M-E, Dufour SP, Schaeffer M, et al. High-force versus low-force lumbar traction in acute lumbar sciatica due to disc herniation: a preliminary randomized trial. J Manip Physiol Ther. 2016;39(9):645–654.
Freeman BJC, Ludbrook GL, Hall S, et al. Randomized, double-blind, placebo-controlled, trial of transforaminal epidural for the treatment of symptomatic lumbar disc herniation. Spine J. 2013;38(23):1986–1994.
Magalhaes FN, Dotta L, Sasse A, et al. Ozone therapy as a treatment for low back pain secondary to herniated disc: a systematic review and meta-analysis of randomized controlled trials. Pain Physician. 2012;15(2):115–129.
Tuakli-Wosornu YA, Terry A, Boachie-Adjei K, et al. Lumbar Intradiskal Platelet-Rich Plasma (PRP) Injections: A Prospective, Double-Blind, Randomized Controlled Study. PM&R. 2016;8(1):1–10.
Kim J, Hur JW, Lee JB, Park JY. Surgery versus nerve blocks for lumbar disc herniation: quantitative analysis of radiological factors as a predictor for successful outcomes. J Korean Neurosurg Soc. 2016;59(5):478–484.
Altun I, Yuksel KZ. Lumbar herniated disc: spontaneous regression. Korean J Pain. 2017;30(1):44–50.
Basso M, Cavagnaro L, Zanirato A, et al. What is the clinical evidence on regenerative medicine in intervertebral disc degeneration? Musculoskelet Surg. 2017;101(2):93–104.
Bhatia R, Chopra G. Efficacy of Platelet Rich Plasma via Lumbar Epidural Route in Chronic Prolapsed Intervertebral Disc Patients-A Pilot Study. J Clin Diagn Res. 2016;10(9):5–10.
DiMauro R, Cantarella G, Bernandini R, et al. The Biochemical and Pharmacological Properties of Ozone: The Smell of Protection in Acute and Chronic Diseases. Int J Mol Sci. 2019;20(3):634–638.
Rowen RJ, Robins H. Ozone Therapy for Complex Regional Pain Syndrome: Review and Case Report. Curr Pain and Headache Rep. 2019;23:41–49.
Borrelli E, Alexandre A, Iliakis E, et al. Disc Herniation and Knee Arthritis as Chronic Oxidative Stress Diseases: The Therapeutic Role of Oxygen Ozone Therapy. Arthritis. 2015;4:161–168.
Re L, Malcangi G, Martinez-Sanchez G. Medical ozone is now ready for a scientific challenge: current status and future perspective. J of Exp and Int Med. 2012;2(3):193–196.
Alyan S, Zaghol R, Mustafa SA. Ozone Therapy for Complex Regional Pain Syndrome: Review and Case Report. Eg Rheum Rehab. 2018;45(3):106–111.
Plopper CG, Duan X, Buckpitt AR, et al. Dose dependent tolerance to ozone. Site-specific elevation in antioxidant enzymes in the lung of rats exposed for 90 days or 20 months. Toxicol Appl Pharmacol J. 2004;127:124–131.
Migliorini F, Maffulli N, Eschweiler J, et al. Ozone injection therapy for intervertebral disc herniation. British Med Bull. 2020;136(1):88–106.
Seyam O, Smith NL, Reid I, et al. Clinical utility of ozone therapy for musculoskeletal disorders. Med Gas Res. 2018;8(3):103–110.
Journals System - logo
Scroll to top