Mycobacterium tuberculosis Infection of the Spine Secondary to Oxygen - Ozone Therapy for Prolapse Intervertebral Disc: A Scoping Review
Salaria AK, Dhatt SS, Kumar V, Neradi D, et al. Journal of Orthopaedic Case Reports, 2021.
- Study type
- Case report
- People studied
- 1 person
- Population
- 55-year-old woman, a farmer, given intradiscal ozone with a steroid at L3/L4 and L4/L5 for prolapsed intervertebral discs at another hospital
- Published
- 2021, Journal of Orthopaedic Case Reports
- Identifiers
- PMID 35437492, DOI 10.13107/jocr.2021.v11.i06.2242
What the authors reported
After intradiscal instillation of 30% ozone (20 ml) with a steroid at L3/L4 and L4/L5, pain returned within 10 days. After 3 months of progressive symptoms she had fever, weight loss, and pre- and paravertebral and epidural collections reaching both psoas muscles, with aspiration cytology positive for acid-fast bacilli. On anti-tuberculosis treatment, MRI at 6 months showed partial healing.
What limits this result
Single case report; the infection is linked to the injection by its history and timing. Tuberculosis was diagnosed from a positive acid-fast stain, and no culture result is reported. Although titled a scoping review, the paper describes no search method, and the patient was still under follow-up on treatment at the time of writing.
Harms reported after ozone therapy, and studies of how ozone exposure affects health. One study rarely settles a medical question; our guides weigh each paper against the rest of the evidence.
How the study was done
- Design
- Case report (the title calls it a scoping review)
We hereby present the first reported case of Mycobacterium infection of the spine secondary to ozone therapy with the aim to caution the surgeons regarding the complications of intradiscal ozone therapy.
- Setting
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India (author affiliation); the injection was given at another hospital
- Read from
- Read from the full text of the paper. Read on October 2, 2026.
Source: Abstract on PubMed
Study arms
| Group | Participants | What they received |
|---|---|---|
| Single patient | Not reported | Percutaneous instillation of 30% ozone (20 ml) with 40 mg of Depo-Medrol, a long-acting steroid, into the L3/L4 and L4/L5 disc spaces |
Source: Full text on PubMed Central
Procedure as reported
- Ozone concentration
- 30% ozone (20 ml), as written
In the paper's own units, not converted.
Source: Full text on PubMed Central
What it measured
- Immediately after the injection
- Uneventful; discharged from hospital the same day
Immediate post-operative period was uneventful and the patient was discharged from the hospital on the same day.
- 10 days after the injection
- Partial relief, then low back pain with left-sided radiculopathy
The patient was partially relieved of the symptoms but 10 days later after the operation, she complained of pain at the lower back along with left-sided radiculopathy.
- Presentation at the authors' center
- Excruciating back pain radiating to both legs, with anorexia, low-grade fever, and weight loss
A 55-year-old female farmer by occupation presented to us with excruciating back pain radiating to her bilateral lower limbs along with the constitutional symptoms of anorexia, low-grade fever, and weight loss.
- Blood tests
- Elevated ESR and CRP, and leukocytosis
The patient was investigated and found to have an elevated erythrocyte sedimentation rate, C-reactive protein, and leukocytosis.
- MRI
- Pre-paravertebral and anterior epidural collections from L2/L3 to L4/L5, narrowing the spinal canal and both foramina
Magnetic resonance imaging (MRI) scan showed pre-paravertebral and anterior epidural collections extending from the L2/L3 to L4/L5 intervertebral disc causing spinal canal and bilateral foramina narrowing.
- Fine-needle aspiration cytology
- Stain positive for acid-fast bacilli
- MRI 6 months after starting anti-tuberculosis treatment
- Partially healed lesion, with less active infection and smaller psoas abscesses on both sides
Repeat MRI after 6 months of starting ATT revealed partially healed lesion with decrease in active infection and reduction in the bilateral psoas abscess
- Literature discussed
- The authors call this the first reported case of M. tuberculosis and the sixth report of spinal infection after intradiscal ozone therapy
Source: Full text on PubMed Central
Safety as reported
Mycobacterial spinal infection after intradiscal ozone therapy, which the authors attribute most likely to direct inoculation of the mycobacteria
Source: Full text on PubMed Central
Follow-up
Ongoing at the time of writing; the last reported MRI was 6 months after anti-tuberculosis treatment beganThe patient is under close follow-up to monitor the response of antitubercular drugs both clinically and radiologically.
Source: Full text on PubMed Central
Funding and conflicts
Conflict of interest: nil
Source: Full text on PubMed Central
Where we cite this study
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