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ORIGINAL RESEARCH ARTICLE

Observational study on the effectiveness of oxygen-ozone treatment vs. pharmacological treatment in patients with chronic low back pain after previous spinal stabilization surgery

Matteo Bonetti1* ,  Michele Frigerio1 ,  Mario Muto2 ,  Giannantonio Pellicanò3 ,  Alessio Zambello4 ,  Cosma Andreula5 ,  Irene Volonghi6 ,  Serena Miglio7 ,  Federico Maffezzoni7
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1 Department of Neuroradiology, Istituto Clinico Città di Brescia, Brescia, Brescia, Italy
2 Department of Neuroradiology, Ospedale Cardarelli, Naples, Naples, Italy
3 Department of Neuroradiology, Azienda Ospedaliera–Universitaria Careggi, Florence, Florence, Italy
4 Department of Anesthesia and Pain Therapy, Casa di Cura Borghi, Brebbia, Varese, Italy
5 Coordinator of Radiology and Neuroradiology, Anthea Hospital, Bari, Bari, Italy
6 Department of Neurology, ASST Spedali Civili di Brescia, Brescia, Brescia, Italy
7 Oberdan Specialist Outpatient Clinic, Brescia, Brescia, Italy
INNOSC Theranostics and Pharmacological Sciences, 026110009 https://doi.org/10.36922/ITPS026110009
Received: 13 March 2026 | Revised: 9 May 2026 | Accepted: 9 May 2026 | Published online: 28 May 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Persistent low back pain after spinal stabilization with instrumentation remains a frequent and clinically demanding condition. In many cases, pain persists despite pharmacological therapy and rehabilitation, limiting quality of life. Among emerging non-surgical options, oxygen–ozone (O2–O3) therapy has been proposed for its analgesic, anti-inflammatory, and neuromodulatory properties. This study aims to evaluate the clinical effectiveness of computed tomography (CT)-guided infiltrative O2–O3 treatment in patients with chronic low back pain following spinal fusion and to compare outcomes with those of standard pharmacological therapy within structured rehabilitative care. This observational retrospective study included 168 adult patients with low back pain persisting for more than six months after posterior spinal fusion with screws and plates. Group A (n = 72) received CT-guided paravertebral infiltrations of an O2–O3 gas mixture at 20 μg/mL, followed by individualized physiotherapy. Group B (n = 96) received a combination of pharmacological agents (oxycodone/ paracetamol and pregabalin) alongside the same rehabilitative program. Clinical evaluation was performed at baseline (T0), 1 month (T1), and 6 months (T2) using the Visual Analog Scale (VAS) and the modified McNab scale. Group A showed a significant mean VAS reduction (>3 points) already at T1, with benefits maintained at T2. Functional recovery was rated as “good” or “excellent” in approximately 60% of cases. In contrast, Group B exhibited a transient response at T1, with VAS scores returning close to baseline at T2. Intergroup differences in both pain reduction and functional improvement were statistically significant (p < 0.001). CT-guided O2–O3 infiltrative therapy, integrated with physiotherapy, was associated with better clinical outcomes compared to pharmacological treatment alone in patients with persistent low back pain after spinal fusion. These findings suggest a potential role for O2–O3 therapy within a multimodal treatment approach for selected post-surgical patients.

Keywords
Low back pain
Spondylolisthesis
O2–O3 therapy
Oxygen–ozone therapy
Computed tomography-guided injections
Interventional neuroradiology
Chronic post-surgical pain
Funding
None.
Conflict of interest
The authors declare no conflicts of interest with respect to the research, authorship, and/or publication of this article.
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