Is ozone helpful in FBSS?Fail

Fail back surgery syndrome (FBSS) is defined as "spinal lower back pain of unknown origin that persists at thesame site of the original pain despite surgical interventions, or appears after the procedure . Its incidence inpatients undergoing back surgery ranges from ۱۲۲ to ۴۰۳ depending on the original surgical technique. Thesymptoms include persistent or recurring low back and/or leg pain. Possible organic causes of FBSS include:epidural fibrosis; arachnoiditis; mechanical factors; inflammation-induced changes in the nerve roots; structuralchanges in the vertebral column; and lumbar degenerative disease. A myofascial pain syndrome (MPS), hasbeen diagnosed in ۸۵.۷% of these patients. Conservative treatments, such as medication and rehabilitation,usually produce unsatisfactory results. Retrospective studies suggest that surgical revisions tend to have lowerrates of improvement than the initial procedure . Lysis of epidural adhesions as been referred to by someauthors as a possible therapeutic option but there is no consensus. Treatment with spinal cord stimulation andintrathecal drug delivery produce good results and although their high costs, when compared with the costsrelated to hospital stay and re-operation or secondary surgeries, these procedures may worth their cost andprovide better long-term results. In the last three decades, the application of ozone has emerged as a potentialtherapeutic option for patients with FBSS. It is suggested that ozone is useful for treating low back pain (LBP)due to its analgesic and anti-inflammatory properties. Although ozone therapy is not validated yet to treatFBSS it has proved to be safe and effective to treat lumbar disc herniation; its cost is low and it is a minimallyinvasive procedure, which yields a new therapeutic option for the FBSS's patients.The intradiscal + intraforaminal approach is simple with no side effects found in this revision and can be agood option until epiduroscopic approach clarifies its efficacy.