Computed tomography-guided oxygen–ozone injection for the treatment of lumbar disc herniation complicated with lumbar spinal stenosis

Chen, Jianchong1,2,#; Song, Zengjie2,#; Zheng, Keya2; Yao, Zhichuan2; Wang, Mengli1; Li, Guoming1; Xu, Jinjin2; Gu, Yufang2; Deng, Shuo3; Chen, Qinqin2,*; Xu, Yun1,*

Author Information

1Center for Rehabilitation Medicine, Department of Pain Management, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang Province, China

2Department of Rehabilitation, Cixi Hospital of Traditional Chinese Medicine, Cixi Integrated Traditional Chinese and Western Medicine Health Group, Ningbo, Zhejiang Province, China

3Department of Pain, the First People’s Hospital of Jiashan County, Zhejiang Province (Jiaxing University Affiliated Jiashan Hospital), Jiaxing, Zhejiang Province, China

*Correspondence to: Qinqin Chen, MD, 1019456432@qq.com; Yun Xu, MD, xuyun65204@163.com

#Both authors contributed equally to this work.

Funding:This study was supported by the Ningbo Health and Technology Plan Project (No. 2023Y81), the 2023 Zhejiang Province Medical and Health Science and Technology Plan Project (County Special Project) (No. 2023XY176), the Zhejiang Province Medical and Health Science and Technology Program (General Project) (No. 2025698472), and the National Natural Science Foundation of China (No. 82372416).

Abstract

Lumbar disc herniation complicated by lumbar spinal stenosis is a common degenerative condition in spinal surgery, particularly among middle-aged and elderly individuals. Conservative treatments or open surgery are commonly used but often have limited efficacy or significant risks, especially in older patients. Oxygen–ozone therapy, known for its mechanical decompression, anti-inflammatory, analgesic, and neuroprotective effects, is gaining attention as a minimally invasive treatment for lumbar disc herniation, offering an alternative to traditional treatments. Therefore, this study aimed to evaluate the clinical therapeutic effect of computed tomography-guided percutaneous oxygen–ozone injection on lumbar disc herniation complicated by lumbar spinal stenosis. This retrospective study analyzed the clinical outcomes of 47 patients with lumbar disc herniation complicated by lumbar spinal stenosis who were treated between September 2023 and February 2024. Patients were divided into two groups: the ozone group received computed tomography-guided percutaneous oxygen–ozone injection (n = 25), and the caudal epidural steroid injection group underwent ultrasound-guided (n = 22). Pain relief and functional outcomes were assessed preoperatively and at 1 day, 1 month, 3 months, and 6 months postoperatively using the visual analog scale, and Oswestry Disability Index and modified MacNab criteria. Both groups showed significant reduction in visual analog scale and Oswestry Disability Index at 1 day and 1 month postoperatively compared with preoperatively (P < 0.05), with the ozone group demonstrating more pronounced improvements than the caudal epidural steroid injection group. At 3 months, although further improvement was observed in both groups, the differences in visual analog scale and Oswestry Disability Index between the two groups were not statistically significant (P > 0.05). By 6 months, the ozone group showed significantly greater improvements than the caudal epidural steroid injection group (P < 0.05). The total effective rate based on modified MacNab criteria increased over time in both groups. Although the ozone group exhibited a slightly higher rate, the difference was not statistically significant (P > 0.05). Computed tomography-guided oxygen–ozone injection provides sustained pain relief and functional recovery in lumbar disc herniation with lumbar spinal stenosis, demonstrating superior long-term efficacy to epidural steroids.

摘要

腰椎间盘突出症合并腰椎管狭窄是脊柱外科常见的退行性疾病，尤其在中老年人群中高发。保守治疗或开放手术是常用方法，但疗效常有限或风险较高，尤其在老年患者中。臭氧治疗因其具有机械减压、抗炎、镇痛和神经保护作用，作为一种治疗腰椎间盘突出症的微创方法正受到关注，为传统治疗提供了替代选择。因此，本研究旨在评估CT引导下经皮穿刺臭氧注射治疗腰椎间盘突出症合并腰椎管狭窄的临床疗效。这项回顾性研究分析了2023年9月至2024年2月期间接受治疗的47例腰椎间盘突出症合并腰椎管狭窄患者的临床结果。患者被分为两组：臭氧组接受CT引导下经皮穿刺臭氧注射（n=25），而骶管类固醇注射组则接受超声引导下注射（n=22）。采用视觉模拟评分法、Oswestry功能障碍指数和改良MacNab标准，在术前及术后1天、1个月、3个月和6个月评估疼痛缓解情况和功能结局。与术前相比，两组在术后1天和1个月的视觉模拟评分和Oswestry功能障碍指数均显著降低（P < 0.05），且臭氧组的改善比骶管类固醇注射组更为明显。术后3个月，尽管两组均有进一步改善，但两组间视觉模拟评分和Oswestry功能障碍指数的差异无统计学意义（P > 0.05）。至术后6个月，臭氧组的改善程度显著优于骶管类固醇注射组（P < 0.05）。根据改良MacNab标准评估的总有效率，两组均随时间推移而提高。尽管臭氧组显示出略高的有效率，但差异无统计学意义（P > 0.05）。CT引导下臭氧注射能为腰椎间盘突出症合并腰椎管狭窄患者提供持续的疼痛缓解和功能恢复，显示出优于硬膜外类固醇注射的长期疗效。