Topical and systemic effect of medical ozone therapy on epidural fibrosis: Experimental research

Epidural fibrosis (EF) causes adhesions in the epidural distance, resulting in chronic low back and leg pain symptoms in the postoperative period. Ozone is used for medical purposes currently in the treatment of lumbar disc herniation and low back pain. Literature supports mitigatory role of ozone in intraperitoneal adhesions occuring after abdominopelvic surgery. Current study aimed investigating the effect of ozone administered topically and systemically in an experimental laminectomy model. Forty seven male Sprague-Dawley rats were divided into four group as follows: (1) sham group (n=12) in which laminectomy was performed and no substance was applied, (2) control group (n=12) which underwent intraoperative washing with 50 ml saline after laminectomy, (3) topical ozone group (n=12) underwent intraoperative washing with 50 ml ozonated distilled water after laminectomy, (4) intraperitoneal ozone group (n=12) in which ozone was administered intraperitoneally (0.7 mg/kg) for seven consecutive days postoperatively. At the end of 4 weeks, all subjects were sacrificed. Histopathological and biochemical data obtained from the tissues were analyzed in terms of EF. There was no statistical significance between groups regarding EF, spinal cord retraction, inflammation, and fibroblast density (respectively; p=0,728, p=0,813, p=0,152, p=0,226). hydroxyproline (HP) levels of tissues was higher in the topical ozone group compared with the intraperitoneal ozone group (p=0,007); however, there was no statistical significance among other groups (p>0,05). In conclusion, intraperitoneal ozone application is superior to its topical application in the prevention of EF. However, further experimental studies are warrented, using different treatment protocols. Keywords: Adhesion, epidural fibrosis, hydroxyproline, laminectomy, ozone.