Spinal Ozone Therapy in Lumbar Spinal Stenosis

Lumbar spinal stenosis (LSS) is the first indication of lumbar surgery in the population over 65 years in the USA, according to the North American Spine Society. Degenerative aetiology is the most common, and as the elderly population grows, this pathology will increase in prevalence. The natural history of LSS shows that there is no need for surgery unless symptoms clearly progress or the clinical situation is unbearable. A high rate of complications with traditional surgery has encouraged the development of minimal invasive surgery and percutaneous techniques like ozone-therapy, for improving quality of life in these patients. In vitro studies have demonstrated the phospholypase A2 blocking action of ozone, which is the same enzyme steroids block to produce their antinflammatory effect. The success of epidural and intraforaminal steroids injections in decreasing surgery rates and the published reports comparing these techniques versus ozone injections encouraged me to use periforaminal ozone injections to treat these patients. Based on the SICOT 953902 protocol widely used in Italy to treat lumbar spondylosis and the works on steroids injections in LSS, an experimental protocol was devised and used in a previous study to determine the indications and the optimal number of sessions in a group of 20 patients. Seventy-two patients have completed the protocol since September 2002 with no drop outs; 59 patients have a one year follow-up. One patient died five months after ending the protocol. No mayor side effects were observed; four patients returned to their baseline during the first year of follow-up. Evaluation was done using the Zurich Claudication Questionaire (ZCQ) and Visual Analogue Scale (VAS) for low back pain and leg pain. These scales were fulfilled by the patients before the treatment and in the follow-up controls at one, three, six and 12 months. Forty-three patients were considered excellent and good results, reaching a ZCQ improvement over 60% or 40%. This is a 74% success rate out in the 58 patients evaluated at one year. Natural history positive evolution rate of LSS has been settled at around 15%, so the protocol seems to be useful for treating LSS patients. A randomized controlled study directly comparing treated and non-treated patients would be necessary to confirm these results.