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Ozone is able to react with proteoglycans, glycosaminoglycans, and other macromolecular complex and to induce galactose glucuronic acid, glycine, and 4-hydroxyproline oxidation. In this way, intra- and intermolecular chemical bonds are broken, releasing an amount of entrapped water. Subsequently, after the water reabsorption, intradiscal and periradicular pressure decrease and as a consequence pain and symptoms improves. Nowadays, oxygen-ozone therapy is increasingly used to treat lumbar disc hernia not responsive to conservative management. In most cases, this therapy is proposed as an alternative to surgery, although its effects could be often only temporary.Patients and Methods   From June 2013, 23 patients (14 M and 9 F, mean age 51.3 years) underwent spinal surgery for lumbar disc hernia or lumbar segmental stenosis. Each of them were previously subjected to ozone therapy in a period between 12 and 24 months. Before surgery, all the patients were subjected to an MRI evaluation, as standard protocol. In eight of them a contrast-enhanced MRI was also performed.Results   During surgery, many hard adhesions between soft tissue and bony structures were evaluated. Specifically, the dural and periradicular adhesions required a more demolition approach, to achieve the resolution of the disease. In one case, an iatrogenic dural cysts with roots invagination was noticed. This lesion was also detected at the preoperative MRI, but it had appeared only after ozone therapy treatment. It is necessary to observe that none of these patients were previously subjected to spine surgery and that these specific pathologic pattern of adhesion were not observed in patients that did not receive ozone therapy.Conclusion   Our observation is a crucial starting point. Although these data are preliminary and it is important not to create unnecessary alarms, it is mandatory to assert that ozone therapy procedure may be associated with major complications. Therefore, it would be necessary a guideline revision and protocols adaptation with regard to ozone therapy application.

Ozone Therapy and Surgical-Related Complications: Preliminary Data and Alert