Paravertebral Intramuscular and Rectal Insufflation Oxygen-Ozone Therapy for Modic 1- Related Low Back Pain: a Case Report

Introduction: Modic type 1 changes on MRI are increasingly recognized as a source of chronic low back pain (cLBP), often resistant to conventional therapies. Oxygen-ozone (O2–O3) therapy (OOT) has emerged as a minimally invasive treatment option due to its analgesic, anti-inflammatory, and immunomodulatory properties. Case presentation: A 68-year-old woman presented with bilateral cLBP and right leg pain, exacerbated in the morning and after inactivity, associated with Modic 1 changes at the L5-S1 level. Previous treatments with analgesics, steroids, and physical therapy were ineffective. From May 2024, the patient received weekly bilateral paravertebral intramuscular O2–O3 injections (10 mL per side, 10 μg/mL) and rectal O2–O3 insufflation (25 μg/ mL, 150 mL/session) for twelve weeks. Significant symptom improvement was noted by the fourth session, with complete resolution by the tenth. Analgesic medications were discontinued after the fourth session. MRI at six months post-treatment showed complete resolution of inflammatory edema and restoration of bone trabeculae, with persistent Modic 2 changes and resorption of a median disc protrusion at L4-L5. Conclusion: This integrated OOT approach (paravertebral intramuscular injections plus rectal insufflation) may represent a promising conservative option in selected patients, but these findings are preliminary and require confirmation in controlled studies before any treatment recommendations can be made