====== Intradiscal Ozone Treatment ======

===== Pain Relief, Disability, and Hospital Costs After Intradiscal Ozone Treatment or Microdiscectomy for Lumbar Disc Herniation: A 24-Month Real-World Prospective Study =====

In a [[prospective]] [[real-world]] [[comparative study]]  
Sara Bisshopp et al.  
from Dr. Negrín University Hospital, [[Las Palmas]]  
published in the [[Journal of Clinical Medicine]] 
to compare [[clinical outcome]]s, [[hospital stay]], and direct [[cost]]s between initial [[intradiscal ozone]] treatment and standard [[microdiscectomy]]/[[discectomy]] in patients with [[lumbar disc herniation]] over a 24-month follow-up.  
Both groups experienced significant improvements in pain and disability scores. The ozone group had similar clinical outcomes to surgery but with significantly fewer surgical [[intervention]]s (47% vs. 100%), shorter hospital stays, and reduced costs at 12 months
((Bisshopp S, Linertová R, Caramés MA, Szolna A, Jorge IJ, Navarro M, Melchiorsen B, Rodríguez-Díaz B, González-Martín JM, Clavo B. Pain Relief, [[Disability]], and [[Hospital Cost]]s After [[Intradiscal Ozone Treatment]] or [[Microdiscectomy]] for Lumbar Disc Herniation: A 24-Month [[Real-World]] [[Prospective Study]]. J Clin Med. 2025 Jun 26;14(13):4534. doi: 10.3390/jcm14134534. PMID: 40648907.)).

==== Critical Appraisal ====

This study taps into a timely and pragmatic clinical question: Can minimally invasive [[ozone therapy]] reduce the surgical burden and costs while maintaining efficacy for [[lumbar disc herniation]]? While the 24-month prospective design and real-world context strengthen [[external validity]], several methodological shortcomings temper enthusiasm.

First, the non-randomized design introduces considerable [[selection bias]]. The criteria for choosing [[ozone therapy]] vs. surgery, though labeled as “offered,” are not rigorously controlled. This self-selection can strongly influence outcomes. Second, sample size is modest (n=70), particularly when divided into two groups (32 ozone, 38 surgery), limiting [[statistical power]].

The lack of [[blinding]], absence of a standardized rehabilitation protocol, and unreported imaging follow-up weaken clinical inference. Although pain and disability scores improved in both groups, the study fails to specify how many in the ozone group eventually needed surgery beyond the 24-month window — crucial for long-term utility claims. Moreover, costs are only directly hospital-related, excluding societal or indirect costs (e.g., work absence).

The statistical methods are valid, but the emphasis on [[p-value]]s without effect sizes or confidence intervals dilutes [[interpretability]]. The claim of “similar outcomes” needs cautious handling—these are primarily subjective scores without radiological correlation.

==== Final Verdict ====

**Takeaway for Neurosurgeons:** Ozone therapy may be a viable, low-cost bridge in selected patients with lumbar disc herniation, potentially delaying or avoiding surgery. However, the lack of randomization, small sample size, and short-term focus make this [[hypothesis-generating]] rather than [[practice-changing]].

**Bottom Line:** Interesting [[real-world]] [[data]] supporting [[ozone therapy]]’s cost and [[hospitalization]] [[advantage]]s, but insufficient evidence to displace surgery in [[standard care]]. Larger, [[randomized trial]]s are essential.

**Score:** **5/10**

**Publication Date:** 2025-06-26  
**Corresponding Author Email: [[bernardino.clavo@saludcanaria.es]]

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Blog Category: Spine Surgery, Minimally Invasive Techniques  
Tags: lumbar disc herniation, intradiscal ozone, microdiscectomy, cost-effectiveness, real-world evidence, pain outcomes, disability scores, hospital stay
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