Cover Image

The ozone: a therapeutic mediator in MODIC processes.


MODIC changes of signal in lumbar MRI offered a new vision of the spine degenerations process. Several theories try to explain this phenomenom. After a critical apraisal and based on our own experience, we propose ozone intradiscal injection as an effective and safe treatment for disc degeneration disease.


vertebral endplate; ozone; MODIC; discography; chronic low lumbar pain

Full Text:



  1. Modic MT, Ross JS. Lumbar degenerative disk disease. Radiology. 2007 Oct;245(1):43-61. doi: 10.1148/radiol.2451051706.

  2. Dudli S, Fields AJ, Samartzis D, Karppinen J, Lotz JC. Pathobiology of Modic changes. Eur Spine J. 2016 Nov;25(11):3723-3734. doi: 10.1007/s00586-016-4459-7. Epub 2016 Feb 25.

  3. Adams MA, Freeman BJ, Morrison HP, Nelson IW, Dolan P. Mechanical initiation of intervertebral disc degeneration. Spine (Phila Pa 1976). 2000 Jul 1;25(13):1625-36. doi: 10.1097/00007632-200007010-00005.

  4. Miller G. The spine. In: Berquist T, editor. MRI of the musculoskeletal system, 2nd edn. New York: Raven; 1990.

  5. Magalhaes FN, Dotta L, Sasse A, Teixera MJ, Fonoff ET. Ozone therapy as a treatment for low back pain secondary to herniated disc: a systematic review and meta-analysis of randomized controlled trials. Pain Physician. 2012;15(2):E115-E129.

  6. Adakli B, Cakar Turhan KS, Asik I. The comparison of the efficacy of radiofrequency nucleoplasty and targeted disc decompression in lumbar radiculopathy. Bosn J Basic Med Sci. 2015 Apr 25;15(2):57-61. doi: 10.17305/bjbms.2015.427.

  7. Burke JG, Watson RW, McCormack D, Dowling FE, Walsh MG, Fitzpatrick JM. Intervertebral discs which cause low back pain secrete high levels of proinflammatory mediators. J Bone J Surg Br. 2002; 84:196-201.

  8. Feng C, Liu H, Yang M, Zhang Y, Huang B, Zhou Y. Disc cell senescence in intervertebral disc degeneration: Causes and molecular Pathways. Cell Cycle. 2016;15(13): 1674-1684.

  9. Rannou F, Ouanes W, Boutron I, Lovisi B, Fayad F, Macé Y, Borderie D, Guerini H, Poiraudeau S, Revel M. High-sensitivity C-reactive protein in chronic low back pain with vertebral end-plate Modic signal changes. Arthritis Rheum. 2007 Oct 15;57(7):1311-5. doi: 10.1002/art.22985. PMID: 17907216.

  10. Borrelli E. Mechanism of action of oxygen ozone therapy in the treatment of disc herniation and low back pain. Acta Neurochir Suppl. 2011;108:123–125.

  11. MacNab I. Negative disc exploration: an analysis of the cause of nerve root involvement in sixty-eight patients. J Bone J Surg (Am). 1971;53:891-903.

  12. Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976). 2000 Nov 15;25(22):2940-52; discussion 2952. doi: 10.1097/00007632-200011150-00017.

  13. Gallucci M, Limbucci N, Zugaro L, Barile A, Stavroulis E, Ricci A, Galzio R, Masciocchi C. Sciatica: treatment with intradiscal and intraforaminal injections of steroid and oxygen-ozone versus steroid only. Radiology. 2007 Mar;242(3):907-13. doi: 10.1148/radiol.2423051934. Epub 2007 Jan 5.

  14. Bonetti M, Fontana A, Cotticelli B, Volta GD, Guindani M, Leonardi M. Intraforaminal O(2)-O(3) versus periradicular steroidal infiltrations in lower back pain: randomized controlled study. AJNR Am J Neuroradiol. 2005 May;26(5):996-1000.

  15. Gautam S, Rastogi V, Jain A, Singh AP. Comparative evaluation of oxygen-ozone therapy and combined use of oxygen-ozone therapy with percutaneous intradiscal radiofrequency thermocoagulation for the treatment of lumbar disc herniation. Pain Pract. 2011 Mar-Apr;11(2):160-6. doi: 10.1111/j.1533-2500.2010.00409.x.

  16. Alexandre A, Corò L, Paradiso R, Dall'aglio R, Alexandre AM, Fraschini F, Spaggiari PG. Treatment of symptomatic lumbar spinal degenerative pathologies by means of combined conservative biochemical treatments. Acta Neurochir Suppl. 2011;108:127-35. doi: 10.1007/978-3-211-99370-5_20.


  • There are currently no refbacks.

WFOTJournal of Ozone Therapy (JO3T)
The Official Peer Reviewed Journal of the World Federation of Ozone Therapy (WFOT)
ISSN 2444-9865