In recent years, the application of ozone nucleus pulposus dissolution surgery in the treatment of discogenic neck and back pain in China has achieved satisfactory results. The treatment mechanism is mainly that ozone can inactivate inflammatory mediators in the intervertebral disc, reduce the impact on painful fine nerves in the disc, and achieve the therapeutic intention. The total reported power in China can reach 81% to 93%. Ozone is one of the strongest oxidants known to be available, and many studies have reported that reactive oxidation products of appropriate concentrations of ozone in the human body can act as physiological activators, leading to various physiological reactions such as affecting the occurrence of multiple cytokines, promoting intercellular information transmission, medium composition, improving cellular oxygen supply and metabolism, etc.
1、 Principles of treatment
The mechanism of ozone therapy for intervertebral disc lesions is not yet fully understood. According to animal and clinical trials, several effects have been found.
（1） Oxidized proteoglycans
This is the primary mechanism of ozone dissolution for treating intervertebral disc lesions. The normal nucleus pulposus is composed of proteoglycans, collagen fiber network, and nucleus pulposus cells.
Proteoglycans are one of the most important macromolecular structures in the nucleus pulposus, capable of absorbing charges into the nucleus pulposus matrix and causing high osmotic pressure, which is the primary factor contributing to the nucleus pulposus water content reaching up to 85%,
(1) Ozone gas injected into the nucleus pulposus can directly oxidize proteoglycan complexes. Ozone combines with water in the nucleus pulposus matrix to generate reactive oxygen species (ROS), which can damage the amino acids in proteoglycan complexes. After proteoglycans are damaged, they lose their characteristic of fixed charge density, and the osmotic pressure of the nucleus pulposus matrix decreases, ultimately leading to the loss of water.
(2) The pathological results of animal experiments conducted by Yu Zhijian and others show that the ultimate effect of ozone on normal nucleus pulposus formation is a reduction in water content, which then leads to a decrease in nucleus pulposus volume and pressure. The significant basis is that the gross specimen can be investigated to show loss of elasticity, color changes, and dryness of the nucleus pulposus, and the nucleus pulposus will not expand when the intervertebral disc is cut open. Under electron microscopy, the large vesicular structures within the nucleus pulposus matrix were not observed.
（2） Damage to nucleus pulposus cells
Experiments have shown that when red blood cells and other human cells are suspended in physiological saline and exposed to ozone, the cell membrane and intracellular membranes are oxidized and lose their function; Ozone can damage unsaturated fatty acids, cholesterol, and other functional proteins in the cell membrane, and then alter the permeability of the cell membrane. In addition, ozone can also cause chromosomal changes in the nucleus, leading to cell death. Animal experiments have also shown that ozone injection into the nucleus pulposus can cause degeneration of nucleus pulposus cells in the early stage, followed by cell necrosis and dissolution; When the nucleus pulposus cells are damaged, they will inevitably form a reduction in the composition and secretion of proteoglycans.
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