Pain Relief and Functional Improvements after Spinal Ozone and PRP Injections for Symptomatic Lumbar Herniated Disc

Background and Objectives: Low back pain may be related to arthritic lumbar facet joints and painful intervertebral discs. Interventional pain management with intraarticular injections of corticosteroids is commonplace. Autologous platelet-rich plasma (PRP) has successfully treated inflammatory pain in large arthritic joints. Additional use of ozone may be beneficial.

Study Design: We conducted a prospective observational cohort study from January 2016 to March 2020 to assess the safety and therapeutic effectiveness of concomitant transforaminal, intradiscaland intraarticular ozone and PRP injections in the management of symptomatic low back pain in patients with herniated disc and facet syndrome.

Setting: The outpatient clinic of a single academic medical center.

Methods: A total of 55 patients with painful lumbar herniated lumbar consisting of 24 women and 31 men with an average age of 48.63 ± 13.54 years and a mean follow-up of 25.84 ± 10.94 months were enrolled in our study. Under x-ray fluoroscopic control, patients received an injection of ozone combined with autologous PRP into the painful herniated disc. At the same time, patients were treated with bilateral lumbar facet joints blocks, transforaminal epidural injection, and a caudal block employing the same therapeutic mixture. Patients were followed up immediately, at one week, 12, 24, 48, and 96 weeks. Functional improvements were evaluated with low back pain visual analog scale (VAS) at rest for leg pain and during flexion, Oswestry Disability Index (ODI), and modified MacNab criteria for the pain relief.

Results: MacNab outcomes were reported excellent by 36.4% of patients, good by 49.1%, fair by 9.1%, and poor by 5.4%. VAS scores decreased from 7.98 ± 1.65 before the procedure to 2.72 ± 2.06 1 week, 2.85 ± 2.12 at 12 weeks, 2.76 ± 2.17 at 24 weeks, 2.58 ± 2.25 at 48 weeks, and 2.52 ± 2.35 at 96 weeks (p < 0.001). The ODI values showed similar reductions from an initial average of 72.65 ± 11.15 before the injection to 30.29 ± 15.67 one week after the procedure followed by 29.85 ± 16.02 at 12 weeks, 28.78 ± 16.74 at 24 weeks, 27.24 ± 17.57 at 48 weeks, 26.4 ± 18.35 at 96 weeks (p < 0.001).

Limitations: Observational cohort study without blinding or randomization.

Conclusion: Our prospective observational cohort study showed rapid pain reduction and functional gains in patients with acute lumbar herniated discs after spinal injections with ozone and activated PRP.