The Effectiveness of Ozone Infiltration on Patient-Reported Outcomes in Low Back Pain: A Systematic Review and Meta-Analysis

Background/Objective: The objective of this systematic review and meta-analysis was to evaluate the current evidence on the relative efficacy of ozone injections for improving patient-reported outcomes (PROMs). Methods: A literature search was conducted in four databases, and PROMs were analyzed. Odds ratios (ORs), mean differences, and standard mean differences with 95% confidence intervals (CI) were calculated. Meta-analysis was performed using Review Manager. Results: Nine studies (total number of participants = 1711) were included. Overall, the ODI (Oswestry Disability Index) showed favorable results for ozone (SMD -0.28, 95% CI -0.51 to -0.06). However, subgroup analysis by follow-up time found no significant differences at 2 weeks or 6 months but significant differences at 1 month. The VAS also favored ozone use overall (SMD -0.12, 95% CI -0.24 -0.01). Subgroup and sensitivity analyses revealed no significant differences between groups. There were also no significant differences in excellent outcomes (OR 0.95, 95% CI 0.54 to 1.67) or poor outcomes (OR 1.25, 95% CI 0.66 to 2.37). Conclusions: Ozone therapy has demonstrated limited benefits over the usual care for lower back pain. While a small advantage emerged for function at one month, the results were inconsistent, and no differences were seen in pain or clinical outcomes.