Chemonucleolysis with Intradiscal Ozone Alone for Lumbar Disc Herniation: A Systematic Review and Meta-analysis of Efficacy, Safety, and Long-term Outcomes

Introduction: Lumbar disc herniation (LDH) is a common condition causing lower back pain (LBP) and radiculopathy. Various treatments, including surgical procedures, have been employed. This study aims to assess the efficacy, safety, and long-term outcomes of chemonucleolysis with intradiscal ozone alone (CIOA) for LDH with LBP.

Methods: Following PRISMA-guidelines, a comprehensive search was conducted across Medline, Embase, Web of Science and Cochrane databases to identify studies reporting on CIOA for LDH with LBP. Mean differences (MD) with 95% confidence intervals were used to compare treatment effects. Main outcome was mean Visual Analogue Scale (VAS) pain score in 1, 3, 6, 12 and 24 months post-procedure. Also, the need for subsequent surgical treatment after the treatment and complications were assessed. Heterogeneity was assessed using I² statistics, and a random-effects model was adopted.

Results: A total of 15 selected studies, involving a total of 765 patients, were included. The MD in VAS, comparing baseline to post-procedure, revealed the following changes: -2.4 (-3.4 to -1.5, I²=98%, 226 patients) at one month of follow-up, -3.08 (-4 to -2.1, I²=96%, 352 patients) at three months, -4 (-5 to -2.9, I²=100%, 412 patients) at six months, -5.3 (-6.4 to -4.2, I²=97%, 231 patients) at one year, and -3.3 (-6.5 to -0.2, I²=99%, 113 patients). Our analysis of the need for subsequent surgical treatment indicated an overall rate of 4% (1%-6%, I²=59%, 342 patients). Lastly, our assessment of complications revealed an estimated overall rate of 1% (0%-4%, I²=4%, 184 patients)

Conclusion : This study found that CIOA demonstrates effective and safe outcomes in patients with LDH and LBP. Substantial reduction in Visual Analogue Scale (VAS) pain scores at various follow-up periods, along with low rates of subsequent surgical intervention and minimal complications, was identified. Additionally, the beneficial results in pain reduction were sustained at the 1-year and 2-year follow-ups. However, high heterogeneity was identified between included studies.