Predictive factors of volumetric reduction in lumbar disc herniation treated by O2-O3 chemiodiscolysis

Predictive factors of volumetric reduction in lumbar disc herniation treated by O2-O3 chemiodiscolysis


  • Alberto Negro Ospedale del Mare – ASL NA1, Neuroradiology Unit,Dipartimento di Scienze Mediche, Chirurgiche, Neurologiche, Metaboliche e dell’invecchiamento, University of Campania “Luigi Vanvitelli”, Naples, Italy
  • Aldo Paolucci Ospedale Maggiore Policlinico Milano, Milan, Italy
  • Camilla Russo Advanced Biomedical Sciences Department University of Naples “Federico II”, Napoli, Italy
  • Martina Di Stasi Advanced Biomedical Sciences Department University of Naples “Federico II”, Napoli, Italy
  • Pasquale Guerriero Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, Campobasso, Italy
  • Francesco Arrigoni Department of Biotechnology and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
  • Federico Bruno Department of Biotechnology and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
  • Francesco Pagnini Department of Medicine and Surgery, Unit of Radiology, University of Parma, Parma, Italy.
  • Salvatore Alessio Angileri Operative Unit of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan University, Via Francesco Sforza, 35, 20122, Milan, Italy.
  • Pierpaolo Palumbo Department of Biotechnology and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
  • Carlo Masciocchi Department of Biotechnology and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
  • Gianfranco Puoti Second Division of Neurology. Department of Advanced Medical and Surgical Sciences, Universityof Campania “Luigi Vanvitelli”, Naples, Italy
  • Fabio Tortora Advanced Biomedical Sciences Department University of Naples “Federico II”, Napoli, Italy
  • Ferdinando Caranci Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy


Lumbar Disc Herniation; Magnetic Resonance Imaging; Chemiodiscolysis; Minimally Invasive Surgery; Oxygen-Ozone Therapy.


Purpose: Aim of this study is to assess the effectiveness of O2-O3 percutaneous chemiodiscolysis by evaluating volumetric changes in lumbar disc herniation on magnetic resonance imaging, in order to identify possible pre-treatment factors affecting such changes Methods: Between January 2014 and December 2017, a total of 87 patients with low back pain and 103 lumbar disc herniations with MRI confirmation were considered for O2-O3 chemiodiscolysis. The volume of each herniated disc was determined before and after the treatment. Results:  Multiple linear regression analysis showed a strong correlation between post-treatment LDH volume percent change and both pre-treatment LDH volume and pre-treatment EQ-VAS (p<0.05), while age showed only a weak positive correlation with post-treatment LDH volume percent change (p<0.1). No association was found for other factors, such as sex and herniation disc level. Conclusions: In conclusion, age, baseline LDH volume and self-assessed disease severity score could represent three easy accessible outcome predictive parameters to consider when intradiscal O2-O3 chemiodiscolysis is envisaged. Better results after intradiscal O2-O3 chemiodiscolysis were obtained in older patients with higher pre-treatment LDH volume and low-moderate pre-treatment EQ-VAS.


Arrigoni F, Bruno F, Zugaro L, et al. Developments in the management of bone metastases with interventional radiology. Acta Biomed 2018; 89: 166-74.

Masciocchi C, Arrigoni F, La Marra A, Mariani S, Zugaro L, Barile A. Treatment of focal benign lesions of the bone: MRgFUS and RFA. The British journal of radiology 2016; 89: 20150356-56.

Tortora F, Cirillo M, Belfiore MP, et al. Spontaneous regression of dilated virchow-robin spaces. A case report. Neuroradiol J 2012; 25: 40-4.

Giordano AV, Arrigoni F, Bruno F, et al. Interventional Radiology Management of a Ruptured Lumbar Artery Pseudoaneurysm after Cryoablation and Vertebroplasty of a Lumbar Metastasis. Cardiovasc Intervent Radiol 2017; 40: 776-79.

Michelini G, Corridore A, Torlone S, et al. Dynamic MRI in the evaluation of the spine: state of the art. Acta Biomed 2018; 89: 89-101.

Cazzato RL, Arrigoni F, Boatta E, et al. Percutaneous management of bone metastases: state of the art, interventional strategies and joint position statement of the Italian College of MSK Radiology (ICoMSKR) and the Italian College of Interventional Radiology (ICIR). Radiol Med 2019; 124: 34-49.

Perri M, Grattacaso G, di Tunno V, et al. T2 shine-through phenomena in diffusion-weighted MR imaging of lumbar discs after oxygen-ozone discolysis: a randomized, double- blind trial with steroid and O2-O3 discolysis versus steroid only. Radiol Med 2015; 120: 941-50.

de Divitiis O, Elefante A. Cervical spinal brucellosis: a diagnostic and surgical challenge. World Neurosurg 2012; 78: 257-9.

Carrafiello G, Fontana F, Mangini M, et al. Initial experience with percutaneous biopsies of bone lesions using Xper- Guide cone-beam CT (CBCT): technical note. Radiol Med 2012; 117: 1386-97.

Giurazza F, Guarnieri G, Murphy KJ, Muto M. Intradiscal O2O3: Rationale, Injection Technique, Short- and Longterm Outcomes for the Treatment of Low Back Pain Due to Disc Herniation. Can Assoc Radiol J 2017; 68: 171-77.

Murphy K, Muto M, Steppan J, Meaders T, Boxley C. Treatment of Contained Herniated Lumbar Discs With Ozone and Corticosteroid: A Pilot Clinical Study. Can Assoc Radiol J 2015; 66: 377-84.

Shanthanna H, Busse JW, Thabane L, et al. Local anesthetic injections with or without steroid for chronic non-cancer pain: a protocol for a systematic review and meta-analysis of randomized controlled trials. Syst Rev 2016; 5: 18.

Kelsey JL, White AA, 3rd. Epidemiology and impact of low-back pain. Spine (Phila Pa 1976) 1980; 5: 133-42.

Bozzao A, Gallucci M, Masciocchi C, Aprile I, Barile A, Passariello R. Lumbar disk herniation: MR imaging assessment of natural history in patients treated without surgery. Radiology 1992; 185: 135-41.

Yasuma T, Arai K, Yamauchi Y. The histology of lumbar intervertebral disc herniation. The significance of small blood vessels in the extruded tissue. Spine (Phila Pa 1976) 1993; 18: 1761-5.

Matsubara Y, Kato F, Mimatsu K, Kajino G, Nakamura S, Nitta H. Serial changes on MRI in lumbar disc herniations treated conservatively. Neuroradiology 1995; 37: 378-83.

Teplick JG, Haskin ME. Spontaneous regression of herniated nucleus pulposus. AJR Am J Roentgenol 1985; 145: 371-5.

Seo JY, Roh YH, Kim YH, Ha KY. Three-dimensional analysis of volumetric changes in herniated discs of the lumbar spine: does spontaneous resorption of herniated discs always occur? Eur Spine J 2016; 25: 1393-402.

Patrick N, Emanski E, Knaub MA. Acute and chronic low back pain. Med Clin North Am 2014; 98: 777-89, xii.

Shah MK, Stewart GW. Sacral stress fractures: an unusual cause of low back pain in an athlete. Spine (Phila Pa 1976) 2002; 27: E104-8.

Demir MK, Yilmaz B, Toktas ZO, Akakin A, Eksi MS, Konya D. An unusual cause of low back pain in a young adult: myxopapillary ependymoma of the filum terminale. Spine J 2016; 16: e321-2.

Leon Salinas JP, Albertz Arevalo N, Belloch Ramos E, Guerrero Espejo A. An unusual cause of low back pain in a patient with sepsis. Enferm Infecc Microbiol Clin 2017; 35: 538-40.

Elefante A, Caranci F, Del Basso De Caro ML, et al. Paravertebral high cervical chordoma. A case report. Neuroradiol J 2013; 26: 227-32.

Bruno F, Arrigoni F, Palumbo P, et al. New advances in MRI diagnosis of degenerative osteoarthropathy of the peripheral joints. Radiol Med 2019; 124: 1121-27.

Arrigoni F, Napoli A, Bazzocchi A, et al. Magnetic-resonance- guided focused ultrasound treatment of non-spinal osteoid osteoma in children: multicentre experience. Pediatr Radiol 2019; 49: 1209-16.

Cortellini A, Bozzetti F, Palumbo P, et al. Weighing the role of skeletal muscle mass and muscle density in cancer patients receiving PD-1/PD-L1 checkpoint inhibitors: a multicenter real-life study. Sci Rep 2020; 10: 1456.

Carrafiello G, Lagana D, Pellegrino C, et al. Ablation of painful metastatic bone tumors: a systematic review. Int J Surg 2008; 6 Suppl 1: S47-52.

Reginelli A, Silvestro G, Fontanella G, et al. Validation of DWI in assessment of radiotreated bone metastases in elderly patients. International Journal of Surgery 2016; 33: S148-S53.

Splendiani A, D’Orazio F, Patriarca L, et al. Imaging of post-operative spine in intervertebral disc pathology. Musculoskelet Surg 2017; 101: 75-84.

Perri M, Grattacaso G, Di Tunno V, et al. MRI DWI/ADC signal predicts shrinkage of lumbar disc herniation after O2-O3 discolysis. Neuroradiol J 2015; 28: 198-204.

Bruno F, Smaldone F, Varrassi M, et al. MRI findings in lumbar spine following O2-O3 chemiodiscolysis: A longterm follow-up. Interv Neuroradiol 2017; 23: 444-50.

Patriarca L, Letteriello M, Di Cesare E, Barile A, Gallucci M, Splendiani A. Does evaluator experience have an impact on the diagnosis of lumbar spine instability in dynamic MRI? Interobserver agreement study. Neuroradiol J 2015; 28: 341-6.

Splendiani A, Bruno F, Patriarca L, et al. Thoracic spine trauma: advanced imaging modality. Radiol Med 2016; 121: 780-92.

Barile A, Arrigoni F, Bruno F, et al. Present role and future perspectives of interventional radiology in the treatment of painful bone lesions. Future Oncol 2018; 14: 2945-55.

Weinstein JN, Lurie JD, Tosteson TD, et al. Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT) observational cohort. JAMA 2006; 296: 2451-59.

Chen BL, Guo JB, Zhang HW, et al. Surgical versus nonoperative treatment for lumbar disc herniation: a systematic review and meta-analysis. Clin Rehabil 2018; 32: 146-60.

Gugliotta M, da Costa BR, Dabis E, et al. Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study. BMJ Open 2016; 6: e012938.

Boos N, Weissbach S, Rohrbach H, Weiler C, Spratt KF, Nerlich AG. Classification of age-related changes in lumbar intervertebral discs: 2002 Volvo Award in basic science. Spine (Phila Pa 1976) 2002; 27: 2631-44.

Dall’Olio M, Princiotta C, Cirillo L, et al. Oxygen-ozone therapy for herniated lumbar disc in patients with subacute partial motor weakness due to nerve root compression. Interv Neuroradiol 2014; 20: 547-54.

Ahn SH, Ahn MW, Byun WM. Effect of the transligamentous extension of lumbar disc herniations on their regression and the clinical outcome of sciatica. Spine (Phila Pa 1976) 2000; 25: 475-80.

Lee J, Kim J, Shin JS, et al. Long-Term Course to Lumbar Disc Resorption Patients and Predictive Factors Associated with Disc Resorption. Evid Based Complement Alternat Med 2017; 2017: 2147408.

Jinkins, Whittemore AR, Bradley WG. The anatomic basis of vertebrogenic pain and the autonomic syndrome associated with lumbar disk extrusion. American Journal of Roentgenology 1989; 152: 1277-89.

van Veluw SJ, Lauer A, Charidimou A, et al. Evolution of DWI lesions in cerebral amyloid angiopathy: Evidence for ischemia. Neurology 2017; 89: 2136-42.

Elefante A, Cavaliere M, Russo C, et al. Diffusion weighted MR imaging of primary and recurrent middle ear cholesteatoma: an assessment by readers with different expertise. Biomed Res Int 2015; 2015: 597896.

Rapalino O, Mullins ME. Intracranial Infectious and Inflammatory Diseases Presenting as Neurosurgical Pathologies. Neurosurgery 2017; 81: 10-28.

Niu X-K, Bhetuwal A, Yang H-F. Diffusion-Weighted Imaging for Pretreatment Evaluation and Prediction of Treatment Effect in Patients Undergoing CT-Guided Injection for Lumbar Disc Herniation. Korean journal of radiology 2015; 16: 874-80.




How to Cite

Predictive factors of volumetric reduction in lumbar disc herniation treated by O2-O3 chemiodiscolysis. Acta Biomed [Internet]. 2020 Jul. 13 [cited 2024 Jun. 23];91(8-S):89-97. Available from: