Ozone disk nucleolysis is a nonsurgical percutaneous procedure for the treatment of discogenic sciatica, and published success rates of ozone disk nucleolysis vary significantly. This study assesses the outcome difference between two treatment modalities among patients with discogenic sciatica secondary to a herniated disk in Bangladesh: Intradiscal ozone injection and combination therapy with intradiscal ozone and transforaminal triamcinolone and bupivacaine injection.

Prospectively recruited 50 patients (group I) received intradiscal injections of an oxygen–ozone mixture and 150 patients (group II) received identical oxygen– ozone injections, followed by transforaminal triamcinolone 20 mg in 2 mL of 0.25% bupivacaine, in relevant foramen. Discography was noted for each case. All patients underwent follow-up examinations at 1-week, 1-month, and 6-month time points. Clinical outcome was evaluated by using the verbal rating scale (VRS) and modified Macnab method.

According to the modified Macnab method, group II showed “excellent and good” result of about 97, 90, and 88% in 1-week, 1-month and 6-month time points respectively, whereas group I showed 70, 70, and 68% at the same time point. The difference is significant in each time point. Groups I and II demonstrated similar VRS scores prior to intervention, but patients in group II had significantly better VRS pain scores at all three time points.

A combination of transforaminal triamcinolone and local anesthetic with intradiscal ozone provides clearly superior outcomes when compared with ozone therapy alone in discogenic sciatica.

Sardar K, Faruque MO, Das G, Hubbard R, Liang NCH, Finkelstein H, Surange PN, Joshi G. A Comparison of Intradiscal Ozone with Transforaminal Triamcinolone and Bupivacaine to Ozone Therapy alone in the Treatment of Discogenic Sciatica. J Recent Adv Pain 2016;2(3):77-81.