Epidural Steroid Injection vs Paravertebral O 2 O 3 Infiltration for Symptomatic Herniated Disc Refractory to Conventional Treatment A Prospective Randomized Study

SUMMARY - The medical management of patients with symptomatic herniated disc of the lumbar spine to treat low back pain, sciatica and cruralgia includes epidural injection of steroids and intramus- cular paravertebral infiltration of an O 2O3 mixture. Our study compared the short (three weeks) and long-term (six months) efficacy of the two treatments after failure to response to conventional medical management (steroids and muscle relaxants). 351 patients were enrolled: 171 (Group A) were treated by epidural steroid injection, while 180 (Group B) underwent paravertebral administration of an O 2O3 mixture. In the short-term 59% of patients treated by epidural injection and 88.2% (p<0.05) of patients treated with O 2O3 had a total or near total remission of pain. Long-term outcome remained excellent or good in 47.3% of patients treated by epidural injection and 77.1% (p<0.05) of patients treated with O2O3. Given the relative simplicity of treatment administration, limited contraindications and the lack of side-effects, ozone therapy is the first choice treatment in patients refractory to conventional medical management.