Combining percutaneous endoscopic lumbar discectomy with ozone injection for lumbar disc herniation and ferroptosis suppression: a randomized clinical trial.

Abstract

The objective was to evaluate percutaneous endoscopic lumbar discectomy (PELD) combined with periradicular ozone injection for lumbar disc herniation (LDH) and to investigate ferroptosis roles in pain relief. Sixty LDH patients were randomly assigned to groups A (PELD only), B (PELD + 20 µg/ml ozone), and C (PELD + 30 µg/ml ozone), with 20 patients per group. Outcomes included visual analog scale (VAS), Oswestry Disability Index (ODI), and Tampa Scale for Kinesiophobia-11 (TSK-11) scores at 1, 4, and 12 weeks postoperatively; pre- and postoperative serum levels of Nrf2, GPX4, and glutathione (GSH); and efficacy based on the modified Macnab criteria. Receiver operating characteristic (ROC) analysis assessed the predictive value of biomarkers. All groups improved postoperatively (p < 0.05). Groups B and C showed lower VAS, ODI, and TSK-11 scores versus group A at 1 and 4 weeks (p < 0.05), with group C outperforming group B early (p < 0.05). No significant differences were observed among the groups in either Macnab outcome evaluation or adverse events. Group C exhibited greater Nrf2, GPX4, and GSH elevation (p < 0.05). ROC curves confirmed Nrf2 (area under the curve [AUC] 0.76), GPX4 (0.75), and GSH (0.75) as significant predictors (p < 0.05). Targeted periradicular ozone injection is a safe and effective adjunct to PELD, enhancing outcomes in LDH patients. A concentration of 30 µg/ml ozone yielded superior early recovery. The authors' findings suggest that pain relief is mediated through ferroptosis suppression, unveiling a novel therapeutic mechanism for ozone therapy.