{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T08:21:24Z","timestamp":1783066884946,"version":"3.54.6"},"reference-count":35,"publisher":"Galenos Yayinevi","issue":"4","license":[{"start":{"date-parts":[[2025,11,9]],"date-time":"2025-11-09T00:00:00Z","timestamp":1762646400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Turk J Phys Med Rehab"],"accepted":{"date-parts":[[2025,3,22]]},"published-print":{"date-parts":[[2025,12,1]]},"abstract":"<jats:p>\n                    <jats:bold>Objectives:<\/jats:bold>\n                    This study aims to assess the clinical effectiveness and safety of transforaminal epidural injections of steroid and ozone mixture versus steroid alone in patients with low back and radicular pain.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Patients and methods:<\/jats:bold>\n                    This retrospective study reviewed the files of 120 patients (60 males, 60 females; mean age: 48.5\u00b112.0 years; range, 18 to 75 years) who underwent fluoroscopy-guided transforaminal epidural steroid or steroid plus ozone injection between June and December 2020. The patients\u2019 clinical and demographic information were noted. Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores were recorded at baseline and one, three, six, and 12 months after the procedure. MacNab scores were evaluated at baseline and 12 months. Postprocedure outcomes were compared with baseline and between the two groups.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results:<\/jats:bold>\n                    Patient characteristics were similar, and both treatment groups showed significant differences in mean VAS and ODI scores compared to baseline (p&lt;0.001). However, the results showed a greater decrease in the combination therapy group (p&lt;0.001). The mean ODI scores were comparable at one, three, and six months but differed at 12 months, with more favorable outcomes in patients who received additional ozone. After a prolonged observation, 61.6% of patients received steroid injections and 78.3% of those who underwent combined treatment were satisfied. The long-term follow-up revealed the absence of significant complications in both treatment groups.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusion:<\/jats:bold>\n                    Transforaminal injection of steroid alone and its combination with ozone were both effective in short- and long-term pain and disability. Additionally, ozone had a moderate effect on the results. Therefore, combining steroids and ozone could be a complementary treatment for better outcomes.\n                  <\/jats:p>","DOI":"10.5606\/tftrd.2025.16087","type":"journal-article","created":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T15:31:38Z","timestamp":1764689498000},"page":"520-530","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy of fluoroscopy-guided transforaminal epidural steroid injection with or without ozone in patients with lumbar radiculopathy: A single-center study"],"prefix":"10.4274","volume":"71","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8184-5184","authenticated-orcid":false,"given":"Derya","family":"Bayram","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4800-3150","authenticated-orcid":false,"given":"\u0130brahim","family":"A\u015f\u0131k","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2811","published-online":{"date-parts":[[2025,11,9]]},"reference":[{"key":"ref-1","doi-asserted-by":"crossref","unstructured":"Manchikanti L, Singh V, Falco FJ, Benyamin RM, Hirsch JA. Epidemiology of low back pain in adults. Neuromodulation 2014;17 Suppl 2:3-10. doi: 10.1111\/ner.12018.","DOI":"10.1111\/ner.12018"},{"key":"ref-2","doi-asserted-by":"crossref","unstructured":"Silva GQ, NBR Alves F, R Afonso JP, MP Soares J, A Souza SK, M Rodrigues-Silva B, et al. Non-invasive therapeutic approaches for mechanical low back pain: an integrative systematic review: non-invasive therapeutic approaches for mechanical low back pain. Man Ther Posturology Rehabil J 2024,22. doi: 10.17784\/mtprehabjournal.2024.22.1382.","DOI":"10.17784\/mtprehabjournal.2024.22.1382"},{"key":"ref-3","doi-asserted-by":"crossref","unstructured":"Carregaro RL, Tottoli CR, Ben \u00c2J, da Silva EN, Bosmans JE, van Tulder M. Cost-utility of Pilates versus home-based exercises in individuals with chronic non-specific low back pain: economic evaluation alongside a randomized controlled trial. JAFF 2024;9:139-40. doi: 10.22563\/2525- 7323.2024.v9.s1.p.124.","DOI":"10.22563\/2525-7323.2024.v9.s1.p.124"},{"key":"ref-4","doi-asserted-by":"crossref","unstructured":"Ad\u0131g\u00fczel E, Tecer D, G\u00fczelk\u00fc\u00e7\u00fck \u00dc, Ta\u015fkaynatan MA, Tan AK. The effectiveness of transforaminal epidural steroid injection in patients with radicular low back pain: Combination of pain provocation with effectiveness results. Turk J Phys Med Rehabil 2017;63:117-23. doi: 10.5606\/ tftrd.2017.05882.","DOI":"10.5606\/tftrd.2017.05882"},{"key":"ref-5","doi-asserted-by":"crossref","unstructured":"Bonetti M, Lauritano D, Ottaviani GM, Fontana A, Frigerio M, Zambello A, et al. New approach to chronic back pain treatment: A case control study. Biomedicines 2022;11:73. doi: 10.3390\/biomedicines11010073.","DOI":"10.3390\/biomedicines11010073"},{"key":"ref-6","unstructured":"Costa T, Linhares D, Ribeiro da Silva M, Neves N. Ozone therapy for low back pain. A systematic review. Acta Reumatol Port 2018;43:172-81."},{"key":"ref-7","doi-asserted-by":"crossref","unstructured":"Hashemi M, Poorfarokh M, Mohajerani SA, Jalili P, Akhyani V, Barikani A, et al. Injection of intradiscal o2-o3 to reduce pain and disability of patients with low back pain due to prolapsed lumbar disk. Anesth Pain Med 2014;4:e19206. doi: 10.5812\/aapm.19206.","DOI":"10.5812\/aapm.19206"},{"key":"ref-8","doi-asserted-by":"crossref","unstructured":"Ryska P, Jandura J, Hoffmann P, Dvorak P, Klimova B, Valis M, et al. Comparison of pulsed radiofrequency, oxygen-ozone therapy and epidural steroid injections for the treatment of chronic unilateral radicular syndrome. Medicina (Kaunas) 2021;57:136. doi: 10.3390\/medicina57020136.","DOI":"10.3390\/medicina57020136"},{"key":"ref-9","doi-asserted-by":"crossref","unstructured":"Fathy W, Hussein M, Ibrahim RE, Abdel-Aziz MM, Adel S, Soliman SH, et al. Comparative effect of transforaminal injection of Magnesium sulphate versus Ozone on oxidative stress biomarkers in lumbar disc related radicular pain. BMC Anesthesiol 2022;22:254. doi: 10.1186\/s12871-022-01789-0.","DOI":"10.1186\/s12871-022-01789-0"},{"key":"ref-10","doi-asserted-by":"crossref","unstructured":"Migliorini F, Maffulli N, Eschweiler J, Bestch M, Tingart M, Baroncini A. Ozone injection therapy for intervertebral disc herniation. Br Med Bull 2020;136:88-106. doi: 10.1093\/bmb\/ ldaa032.","DOI":"10.1093\/bmb\/ldaa032"},{"key":"ref-11","doi-asserted-by":"crossref","unstructured":"Bocci V, Borrelli E, Zanardi I, Travagli V. The usefulness of ozone treatment in spinal pain. Drug Des Devel Ther 2015;9:2677-85. doi: 10.2147\/DDDT.S74518.","DOI":"10.2147\/DDDT.S74518"},{"key":"ref-12","unstructured":"Bonetti M, Fontana A, Cotticelli B, Volta GD, Guindani M, Leonardi M. Intraforaminal O(2)-O(3) versus periradicular steroidal infiltrations in lower back pain: Randomized controlled study. AJNR Am J Neuroradiol 2005;26:996- 1000."},{"key":"ref-13","doi-asserted-by":"crossref","unstructured":"Unal-Cevik I, Sarioglu-Ay S, Evcik D. A comparison of the DN4 and LANSS questionnaires in the assessment of neuropathic pain: validity and reliability of the Turkish version of DN4. J Pain 2010;11:1129-35. doi: 10.1016\/j. jpain.2010.02.003.","DOI":"10.1016\/j.jpain.2010.02.003"},{"key":"ref-14","doi-asserted-by":"crossref","unstructured":"Haseeb A, Abd El Hares A, Abd El Moez K, Mustafa A, Ahmed O. Comparative study between treatment of lumbar disc herniation with intra discal ozone and transforaminal steroid injection versus steroid injection only. The Egyptian Journal of Hospital Medicine 2019;74:705-20. doi: 10.21608\/ ejhm.2019.24068.","DOI":"10.21608\/ejhm.2019.24068"},{"key":"ref-15","doi-asserted-by":"crossref","unstructured":"Chemeisani A, Tarhini H, Haj Ali T, Jibbawi AA, Yehya K, Msheik A. The benefit of epidural transforaminal injection of ozone in comparison with transforaminal steroids \u0131njection in the management of chronic low back pain in Lebanese population: One-year retrospective study. Cureus 202315:e34106. doi: 10.7759\/cureus.34106.","DOI":"10.7759\/cureus.34106"},{"key":"ref-16","doi-asserted-by":"crossref","unstructured":"Yakut E, D\u00fcger T, Oks\u00fcz C, Y\u00f6r\u00fckan S, Ureten K, Turan D, et al. Validation of the Turkish version of the Oswestry Disability Index for patients with low back pain. Spine (Phila Pa 1976) 2004;29:581-5. doi: 10.1097\/01. brs.0000113869.13209.03.","DOI":"10.1097\/01.BRS.0000113869.13209.03"},{"key":"ref-17","doi-asserted-by":"crossref","unstructured":"Macnab I. Negative disc exploration. An analysis of the causes of nerve-root involvement in sixty-eight patients. J Bone Joint Surg Am 1971;53:891-903.","DOI":"10.2106\/00004623-197153050-00004"},{"key":"ref-18","doi-asserted-by":"crossref","unstructured":"Christelis N, Simpson B, Russo M, Stanton-Hicks M, Barolat G, Thomson S, et al. Persistent spinal pain syndrome: A proposal for failed back surgery syndrome and ICD-11. Pain Med 2021;22:807-18. doi: 10.1093\/pm\/pnab015.","DOI":"10.1093\/pm\/pnab015"},{"key":"ref-19","doi-asserted-by":"crossref","unstructured":"Andreula C. Lumbar herniated disk and degenerative changes. Interventional spinal treatment with chemiodiscolysis with nucleoptesis with O3 and perigangliar infiltration in 150 cases. Rivista di Neuroradiologia 2002;14:81-8. doi: 10.1177\/19714009010140S118.","DOI":"10.1177\/19714009010140S118"},{"key":"ref-20","doi-asserted-by":"crossref","unstructured":"Muto M, Avella F. Percutaneous treatment of herniated lumbar disc by intradiscal oxygen-ozone injection. Interv Neuroradiol 1998;4:279-86. doi: 10.1177\/159101999800400403.","DOI":"10.1177\/159101999800400403"},{"key":"ref-21","doi-asserted-by":"crossref","unstructured":"Gallucci M, Limbucci N, Zugaro L, Barile A, Stavroulis E, Ricci A, et al. Sciatica: Treatment with intradiscal and intraforaminal injections of steroid and oxygen-ozone versus steroid only. Radiology 2007;242:907-13. doi: 10.1148\/ radiol.2423051934.","DOI":"10.1148\/radiol.2423051934"},{"key":"ref-22","doi-asserted-by":"crossref","unstructured":"Perri M, Marsecano C, Varrassi M, Giordano AV, Splendiani A, di Cesare E, et al. Indications and efficacy of O2-O3 intradiscal versus steroid intraforaminal injection in different types of disco vertebral pathologies: A prospective randomized double-blind trial with 517 patients. Radiol Med 2016;121:463-71. doi: 10.1007\/s11547-015-0598-x.","DOI":"10.1007\/s11547-015-0598-x"},{"key":"ref-23","unstructured":"Zambello A, Fara B, Tabaracci G, Bianchi M. Epidural steroid injection vs paravertebral O2-O3 infiltration for symptomatic herniated disc refractory to conventional treatment: A prospective randomized study. Rivista di Neuroradiologia 2006;5:123-127."},{"key":"ref-24","doi-asserted-by":"crossref","unstructured":"Joel JJ, Dutta D, Das G, Anand Kumar GS, Panchal J, Basak S. Efficacy of transforaminal epidural steroid injection versus intraforaminal or periforaminal ozone for low back pain with radiculopathy Indian J Pain. 2015;29:64-72. doi: 10.4103\/0970-5333.155172.","DOI":"10.4103\/0970-5333.155172"},{"key":"ref-25","doi-asserted-by":"crossref","unstructured":"Hidalgo-Tall\u00f3n FJ, Torres-Morera LM, Baeza-Noci J, Carrillo-Izquierdo MD, Pinto-Bonilla R. Updated review on ozone therapy in pain medicine. Front Physiol 2022;13:840623. doi: 10.3389\/fphys.2022.840623.","DOI":"10.3389\/fphys.2022.840623"},{"key":"ref-26","doi-asserted-by":"crossref","unstructured":"Spijker-Huiges A, Winters JC, van Wijhe M, Groenier K. Steroid injections added to the usual treatment of lumbar radicular syndrome: A pragmatic randomized controlled trial in general practice. BMC Musculoskelet Disord 2014;15:341. doi: 10.1186\/1471-2474-15-341.","DOI":"10.1186\/1471-2474-15-341"},{"key":"ref-27","doi-asserted-by":"crossref","unstructured":"Karppinen J, Malmivaara A, Kurunlahti M, Kyll\u00f6nen E, Pienim\u00e4ki T, Nieminen P, et al. Periradicular infiltration for sciatica: A randomized controlled trial. Spine (Phila Pa 1976) 2001;26:1059-67. doi: 10.1097\/00007632-200105010- 00015.","DOI":"10.1097\/00007632-200105010-00015"},{"key":"ref-28","doi-asserted-by":"crossref","unstructured":"Muto M, Andreula C, Leonardi M. Treatment of herniated lumbar disc by intradiscal and intraforaminal oxygenozone (O2-O3) injection. J Neuroradiol 2004;31:183-9. doi: 10.1016\/s0150-9861(04)96989-1.","DOI":"10.1016\/S0150-9861(04)96989-1"},{"key":"ref-29","doi-asserted-by":"crossref","unstructured":"Zhang Y, Ma Y, Jiang J, Ding T, Wang J. Treatment of the lumbar disc herniation with intradiscal and intraforaminal injection of oxygen-ozone. J Back Musculoskelet Rehabil 2013;26:317-22. doi: 10.3233\/BMR-130386.","DOI":"10.3233\/BMR-130386"},{"key":"ref-30","unstructured":"Andreula CF, Simonetti L, De Santis F, Agati R, Ricci R, Leonardi M. Minimally invasive oxygen-ozone therapy for lumbar disk herniation. AJNR Am J Neuroradiol 2003;24:996-1000."},{"key":"ref-31","doi-asserted-by":"crossref","unstructured":"Nazemian NA, Khajehnasiri A, Sanatkar M, Samavatian M, Nikoo MR. Efficacy of lumbar transforaminal epidural steroid injection with or without ozone therapy on radicular pain. Arch Anesth & Crit Care 2024;10:377-84. doi: 10.18502\/aacc.v10i4.16267.","DOI":"10.18502\/aacc.v10i4.16267"},{"key":"ref-32","doi-asserted-by":"crossref","unstructured":"Vanni D, Galzio R, Kazakova A, Pantalone A, Sparvieri A, Salini V, et al. Intraforaminal ozone therapy and particular side effects: Preliminary results and early warning. Acta Neurochir (Wien) 2016;158:491-6. doi: 10.1007\/s00701-015-2545-y.","DOI":"10.1007\/s00701-015-2545-y"},{"key":"ref-33","doi-asserted-by":"crossref","unstructured":"Devetag Chalaupka F, Caneve G, Mauri M, Zaiotti G. Thunderclap headache caused by minimally invasive medical procedures: Description of 2 cases. Headache 2007;47:293-5. doi: 10.1111\/j.1526-4610.2006.00699.x.","DOI":"10.1111\/j.1526-4610.2006.00699.x"},{"key":"ref-34","doi-asserted-by":"crossref","unstructured":"Ginanneschi F, Cervelli C, Milani P, Rossi A. Ventral and dorsal root injury after oxygen-ozone therapy for lumbar disk herniation. Surg Neurol 2006;66:619-20. doi: 10.1016\/j. surneu.2006.01.025.","DOI":"10.1016\/j.surneu.2006.01.025"},{"key":"ref-35","doi-asserted-by":"crossref","unstructured":"Magalhaes FN, Dotta L, Sasse A, Teixera MJ, Fonoff ET. Ozone therapy as a treatment for low back pain secondary to herniated disc: A systematic review and meta-analysis of randomized controlled trials. Pain Physician 2012;15:E115-29.","DOI":"10.36076\/ppj.2012\/15\/E115"}],"container-title":["Turkish Journal of Physical Medicine and Rehabilitation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ftrdergisi.com\/uploads\/pdf\/pdf_4620.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ftrdergisi.com\/uploads\/pdf\/pdf_4620.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T08:08:38Z","timestamp":1783066118000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ftrdergisi.com\/uploads\/pdf\/pdf_4620.pdf"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,9]]},"references-count":35,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,12,1]]}},"URL":"https:\/\/doi.org\/10.5606\/tftrd.2025.16087","relation":{},"ISSN":["2587-1250"],"issn-type":[{"value":"2587-1250","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,9]]}}}