CT-guided transforaminal versus C-arm-guided intradiscal ozone injection for cervical disc herniation: a comparative cohort study

Objective This study compares a novel, disc-preserving minimally invasive technique targeting intraforaminal inflammation—CT-guided transforaminal ozone injection (Group A)—with the conventional intradiscal decompression approach using C-arm-guided injection (Group B) for the treatment of cervical disc herniation (CDH). Methods A retrospective cohort study was conducted on 398 patients with CDH treated between January 2020 and June 2024. Patients were divided into two groups based on the treatment received: Group A ( n = 200), who received CT-guided transforaminal injections targeting the inflamed nerve root, and Group B ( n = 198), who received C-arm-guided intradiscal injections. Primary outcomes included the Visual Analogue Scale (VAS) for pain, the Neck Disability Index (NDI) for function, and overall efficacy assessed by the modified MacNab criteria. Secondary outcomes included procedural parameters and complication rates. Assessments were performed preoperatively and at 1 week, 1 month, 3 months, and 6 months post-procedure. Results Both groups showed significant postoperative improvements in VAS and NDI scores ( p < 0.05). However, from 1 month onward, Group A demonstrated significantly lower (better) VAS and NDI scores compared to Group B ( p < 0.05). At the 6-month follow-up, the rate of “excellent” or “good” outcomes per MacNab criteria was significantly higher in Group A (93.0%) than in Group B (86.4%) ( p = 0.026). Group A had a longer mean procedure time but significantly less radiation exposure ( p < 0.001). Critically, no major complications, particularly discitis, occurred in Group A. In contrast, Group B had two cases (1.0%) of suspected discitis and a significantly higher rate of transient symptom exacerbation ( p = 0.014). Conclusion CT-guided transforaminal ozone injection, a technique predicated on targeting intraforaminal inflammation rather than conventional intradiscal decompression, is associated with better 6-month outcomes for CDH. It provides more effective pain relief and functional improvement while demonstrating an enhanced safety profile by preserving disc integrity and eliminating the risk of iatrogenic discitis. These findings establish this approach as a precise, safe, and highly promising minimally invasive treatment strategy for cervical radiculopathy.