Published in Eleftheros Typos · Co-authored with Dr. Michail Digenis, General Practitioner specializing in ozone therapy
In carefully selected patients, ozone therapy can be a valuable option with very good results, offering relief from sciatica and low back pain.
We frequently see patients presenting with sciatica or low back pain in whom MRI reveals a herniated disc, spinal stenosis, or instability — causing compression and irritation of the nerves and surrounding structures, and producing these distressing symptoms. What are the options?
Where ozone therapy fits among the alternatives
Surgery is always the last resort. Before it — and even before medication and interventional procedures — come lifestyle measures: avoiding heavy lifting, strengthening the abdominal and back muscles, rest, and specialist follow-up. Together these can resolve the problem in up to 70% of patients, although in the acute phase many of them are not feasible.
Where they cannot be applied or prove ineffective, pharmacological treatment is usually the next step. Medication is a reasonable option, but often has to be taken long term; some drugs cannot be given safely for prolonged periods and carry contraindications and side effects that make them unsuitable for certain patients. Its efficacy also does not typically exceed 70%.
When a patient does not improve on medication, or cannot take it, several minimally invasive options may be tried before surgery is considered — including local injections of analgesic or anti-inflammatory agents at the site of pain, and anti-inflammatory injections into the epidural space. Properly applied, these can achieve success rates of up to 70%, allowing the patient to avoid an operation. Should they fail and surgery be decided upon, surgical efficacy falls within a similar or somewhat higher range (70–90%).
Ozone therapy
Among the minimally invasive methods is the use of medical ozone. The technique has a defined mechanism of action and is used in several countries, including Switzerland, Germany, and Italy, as well as at various university centers in Europe. Published studies suggest a possible benefit, and some series report high response rates. The overall certainty of this evidence is, however, low: there is no Cochrane review of ozone therapy for sciatica, several of the positive studies carry declared conflicts of interest, and the method is not approved as a therapeutic agent in the United States. We therefore present ozone therapy as a complementary option that may be considered in selected patients, and not as an alternative of proven equivalence to surgical decompression.
Ozone acts by normalizing cytokine and prostaglandin levels, producing anti-inflammatory and analgesic effects. Its effect can also be visible on MRI: post-treatment imaging may show reduced inflammation, marked disc dehydration, and a significant increase in the space within the spinal canal through which the nerves travel.
How ozone therapy is performed
The method is based on paravertebral intramuscular injection of a medical oxygen–ozone gas mixture, close to the affected area. After administration, enzymatic activation leads to the inactivation of free radicals, enhancing the body’s natural repair mechanisms and neutralizing the formation of reactive molecules. The result is a reduction in inflammation and in disc volume, and therefore in the pressure exerted on the neural structures — culminating in symptom relief.
As with most methods based on local administration of a substance into the spine, ozone therapy is most effective for localized lumbar pain, that is, low back pain. Because its anti-inflammatory action extends a reasonable distance from the injection site, however, it may also benefit cases of sciatica.
In patients who have already undergone surgery without adequate results, ozone therapy is a reasonable option alongside other minimally invasive techniques, since it carries substantially lower complication rates at comparable levels of efficacy. It is also acceptable as a first-line option, particularly for patients who prefer to avoid pharmacological treatment, or who have contraindications or side effects to it.
