Efficacy of transforaminal epidural steroid injection versus intraforaminal or periforaminal ozone for low back pain with radiculopathy

To compare the effectiveness of transforaminal epidural steroid injection (TFESI) vs Periforaminal ozone in low back pain with radiculopathy. Literature search was done from MEDLINE and PUBMED sites. Observational studies in both steroid and ozone groups clearly favouring each other whereas there was a significant difference between the RCT′s in either group. 3 RCT′s out of 4 favouring ozone treatment whereas only 2 out of 8 RCT′s were in favour of epidural steroids. Comparison studies showed results more in favour of combined steroid and ozone. 2 RCT′s and 1 observational study were in favour of combined ozone and steroid whereas 2 RCT′s favoured ozone better than steroid and ozone. Currently studies have shown epidural steroids to be effective in inflammatory origin of pain as its proven by its short duration of action whereas ozone was shown to be effective in both short and long term mainly because of its anti inflammatory action which took care of the short term pain and its ability to denature the proteins of disc material and correct the underlying pathology resulting in effective long term relief. Studies have also shown cumulative effects of ozone and epidural steroids and we would recommend a careful selection of patients for ozone or steroid to increase the success rate and further studies would be needed to know their true potential in low back pain due to radiculopathy.