Oxygen–ozone therapy in lumbar disc herniation and lumbar radiculopathy: A narrative review

Lumbar disc herniation is a common cause of low back pain and lumbar radiculopathy. It results from disruption of the annulus fibrosus, allowing displacement of the nucleus pulposus and subsequent nerve root compression. Beyond mechanical compression, inflammatory mediators released from the disc contribute to radicular pain, neurological symptoms, and functional impairment, substantially affecting patients’ quality of life.
Although conservative treatment and surgery remain the main therapeutic approaches for lumbar disc herniation and lumbar radiculopathy, many patients evolve into an intermediate clinical stage characterized by persistent symptoms despite adequate conservative management and the absence of a clear surgical indication. This therapeutic gap has stimulated interest in minimally invasive interventions. Among these, oxygen–ozone (O₂–O₃) therapy has emerged as a promising option combining biochemical disc decompression with anti-inflammatory and immunomodulatory properties, potentially serving as an adjunct to comprehensive rehabilitation programs.
A narrative literature review was conducted using electronic databases including PubMed, Scopus, and Google Scholar. Relevant publications addressing ozone therapy for lumbar disc herniation and lumbar radiculopathy were analyzed, with particular attention to biological mechanisms, clinical outcomes, safety profile, and integration into rehabilitation strategies.
Lumbar radiculopathy results from a combination of mechanical nerve root compression and inflammatory processes, including chemical radiculitis and periradicular edema. Oxygen–ozone therapy acts through complementary mechanisms. Its primary effect involves biochemical disc decompression through oxidation of nucleus pulposus proteoglycans, leading to disc dehydration, reduction of intradiscal pressure, and decreased nerve root compression. In addition, ozone exerts anti-inflammatory and immunomodulatory effects that may reduce periradicular edema and radicular irritation. Improved microcirculation and tissue oxygenation may also contribute to pain relief and functional recovery.
Oxygen–ozone therapy represents a promising minimally invasive option targeting both the mechanical and inflammatory components of lumbar radiculopathy secondary to disc herniation. Positioned between conservative management and surgery, it may provide an effective therapeutic option in appropriately selected patients and may be integrated into comprehensive rehabilitation programs. Nevertheless, further high-quality studies are required to clarify its long-term efficacy and optimal indications.