{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:07:10Z","timestamp":1776096430067,"version":"3.50.1"},"reference-count":98,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,23]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Sixty LDH patients were randomly assigned to groups A (PELD only), B (PELD + 20 \u00b5g\/ml ozone), and C (PELD + 30 \u00b5g\/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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>All groups improved postoperatively (p &lt; 0.05). Groups B and C showed lower VAS, ODI, and TSK-11 scores versus group A at 1 and 4 weeks (p &lt; 0.05), with group C outperforming group B early (p &lt; 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 &lt; 0.05). ROC curves confirmed Nrf2 (area under the curve [AUC] 0.76), GPX4 (0.75), and GSH (0.75) as significant predictors (p &lt; 0.05).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Targeted periradicular ozone injection is a safe and effective adjunct to PELD, enhancing outcomes in LDH patients. A concentration of 30 \u00b5g\/ml ozone yielded superior early recovery. The authors\u2019 findings suggest that pain relief is mediated through ferroptosis suppression, unveiling a novel therapeutic mechanism for ozone therapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.9.spine25581","type":"journal-article","created":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T17:11:55Z","timestamp":1770829915000},"page":"537-546","source":"Crossref","is-referenced-by-count":0,"title":["Combining percutaneous endoscopic lumbar discectomy with ozone injection for lumbar disc herniation and ferroptosis suppression: a randomized clinical trial"],"prefix":"10.3171","volume":"44","author":[{"given":"Hanbin","family":"Wang","sequence":"first","affiliation":[{"name":"The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou First People\u2019s Hospital, Hangzhou;"},{"name":"Department of Pain, Affiliated Hangzhou First People\u2019s Hospital, Westlake University School of Medicine, Hangzhou;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li","family":"Xu","sequence":"additional","affiliation":[{"name":"The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou First People\u2019s Hospital, Hangzhou;"},{"name":"Department of Pain, Affiliated Hangzhou First People\u2019s Hospital, Westlake University School of Medicine, Hangzhou;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiayi","family":"Deng","sequence":"additional","affiliation":[{"name":"The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou First People\u2019s Hospital, Hangzhou;"},{"name":"Department of Pain, Affiliated Hangzhou First People\u2019s Hospital, Westlake University School of Medicine, Hangzhou;"},{"name":"Department of Pain, Wuxi Xishan People\u2019s Hospital, Wuxi, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xu","family":"Qiu","sequence":"additional","affiliation":[{"name":"The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou First People\u2019s Hospital, Hangzhou;"},{"name":"Department of Pain, Affiliated Hangzhou First People\u2019s Hospital, Westlake University School of Medicine, Hangzhou;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chengqi","family":"Dong","sequence":"additional","affiliation":[{"name":"The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou First People\u2019s Hospital, Hangzhou;"},{"name":"Department of Pain, Affiliated Hangzhou First People\u2019s Hospital, Westlake University School of Medicine, Hangzhou;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuzhong","family":"Hu","sequence":"additional","affiliation":[{"name":"The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou First People\u2019s Hospital, Hangzhou;"},{"name":"Department of Pain, Affiliated Hangzhou First People\u2019s Hospital, Westlake University School of Medicine, Hangzhou;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qinghua","family":"Li","sequence":"additional","affiliation":[{"name":"The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou First People\u2019s Hospital, Hangzhou;"},{"name":"Department of Pain, Affiliated Hangzhou First People\u2019s Hospital, Westlake University School of Medicine, Hangzhou;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tao","family":"Mei","sequence":"additional","affiliation":[{"name":"The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou First People\u2019s Hospital, Hangzhou;"},{"name":"Department of Pain, Affiliated Hangzhou First People\u2019s Hospital, Westlake University School of Medicine, Hangzhou;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shi","family":"Chen","sequence":"additional","affiliation":[{"name":"The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou First People\u2019s Hospital, Hangzhou;"},{"name":"Department of Pain, Affiliated Hangzhou First People\u2019s Hospital, Westlake University School of Medicine, Hangzhou;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yali","family":"Wu","sequence":"additional","affiliation":[{"name":"The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou First People\u2019s Hospital, Hangzhou;"},{"name":"Department of Pain, Affiliated Hangzhou First People\u2019s Hospital, Westlake University School of Medicine, Hangzhou;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lihua","family":"Miao","sequence":"additional","affiliation":[{"name":"The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou First People\u2019s Hospital, Hangzhou;"},{"name":"Department of Pain, Affiliated Hangzhou First People\u2019s Hospital, Westlake University School of Medicine, Hangzhou;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fengyun","family":"Huang","sequence":"additional","affiliation":[{"name":"The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou First People\u2019s Hospital, Hangzhou;"},{"name":"Department of Pain, Affiliated Hangzhou First People\u2019s Hospital, Westlake University School of Medicine, Hangzhou;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manli","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Mental Disorder\u2019s Management of Zhejiang Province, Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, Zhejiang; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuan","family":"Cheng","sequence":"additional","affiliation":[{"name":"The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou First People\u2019s Hospital, Hangzhou;"},{"name":"Department of Pain, Affiliated Hangzhou First People\u2019s Hospital, Westlake University School of Medicine, Hangzhou;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianliang","family":"Sun","sequence":"additional","affiliation":[{"name":"The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou First People\u2019s Hospital, Hangzhou;"},{"name":"Department of Pain, Affiliated Hangzhou First People\u2019s Hospital, Westlake University School of Medicine, Hangzhou;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liang","family":"Yu","sequence":"additional","affiliation":[{"name":"The Fourth School of Clinical Medicine, Zhejiang Chinese Medical 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