Spondylodiscitis Following Oxygen-Ozone Therapy: A Case Report of Lactobacillus iners Infection and a Systematic Literature Review
Velluto C, Mazzella GG, Inverso M, Borruto MI, et al. Diseases (Basel), 2026.
- Study type
- Case report
- People studied
- 1 person
- Population
- Immunocompetent 55-year-old woman given five sessions of intradiscal oxygen-ozone for an L4-L5 disc herniation; the review covers published cases of spondylodiscitis after such therapy
- Published
- 2026, Diseases (Basel)
- Identifiers
- PMID 41892016, DOI 10.3390/diseases14030115
What the authors reported
After five sessions of intradiscal oxygen-ozone in March 2022 for an L4-L5 herniation, pain worsened from July; CRP was 91 mg/L and MRI showed L4-L5 spondylodiscitis. Biopsy identified Lactobacillus iners, and she recovered fully after decompression and intravenous antibiotics. The review found eight earlier cases with varied pathogens; all but one, a death from septic shock, ended favorably.
What limits this result
Single case; the authors state that a direct causal link cannot be proven. The review rests on a few case reports, its abstract gives both six included and eight identified cases, and the authors cite incomplete microbiological data and publication bias. The paper's conflict-of-interest section holds a consent sentence rather than a declaration.
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 with a systematic literature review
Spondylodiscitis Following Oxygen-Ozone Therapy: A Case Report of Lactobacillus iners Infection and a Systematic Literature Review
- Setting
- Department of Aging, Orthopaedic and Rheumatological Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy (author affiliation)
- 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 | Five sessions of intradiscal oxygen-ozone therapy in March 2022 for an L4-L5 disc herniation, with partial relief at first |
Source: Full text on PubMed Central
Procedure as reported
- Sessions
- Five intradiscal sessions in March 2022
the patient underwent five sessions of oxygen–ozone (O 2 –O 3 ) intradiscal therapy
In the paper's own units, not converted.
Source: Full text on PubMed Central
What it measured
- Course after the sessions
- Progressive worsening of low back and sciatic pain from July 2022, over three months
- Blood tests, September 2022
- Neutrophilic leukocytosis and C-reactive protein of 91 mg/L
- Contrast-enhanced lumbar MRI
- Abnormal enhancement of the dural sac and the L4 and L5 endplates, suggestive of infection and absent on the February 2022 MRI
Post-contrast sequences revealed abnormal enhancement of the dural sac and vertebral endplates at L4 and L5, suggestive of an infectious process, which had not been observed on the previous MRI performed in February 2022.
- Surgical biopsy
- Lactobacillus iners confirmed as the pathogen
- Follow-up MRI, January 2023
- No active bone infection or residual paravertebral abscess
- Systematic review: search
- PubMed, MEDLINE, and Scopus searched for reports of spondylodiscitis after oxygen-ozone therapy
- Systematic review: cases and pathogens
- 8 cases: S. aureus, beta-haemolytic streptococcus, E. coli, Achromobacter xylosoxidans, M. abscessus, S. intermedius, and one culture-negative infection
- Systematic review: outcomes
- Favorable in all cases except one fatality
Safety as reported
Lactobacillus iners spondylodiscitis after intradiscal oxygen-ozone therapy; the authors state a direct causal link cannot be proven but call the association plausibleAlthough a direct causal relationship cannot be proven, the temporal sequence and the absence of alternative sources of infection suggest a plausible association.
Source: Full text on PubMed Central
Follow-up
Final follow-up (length not stated): brace discontinued, complete resolution of pain, and full functional recovery
Source: Full text on PubMed Central
Funding and conflicts
No external funding
Source: Full text on PubMed Central
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