COMBINED OXYGEN-OZONE THERAPY AND INJECTABLE PORCINE COLLAGEN IN THE TREATMENT OF MODIC TYPE I OSTEOCHONDROSIS: BIOLOGICAL RATIONALE FOCUSING ON ANTI-INFLAMMATORY AND ANALGESIC MECHANISMS

¹ Department of Neuroradiology, Clinical Institute, “Città di Brescia”, Brescia, Italy
² Oberdan Specialist Outpatient Clinic, Brescia, Italy
³ Department of Neurosurgery, ASST Spedali Civili di Brescia, University of Brescia, 25123 Brescia, Italy

Correspondence to:

Journal of Orthopedics 2026 January-April; 18(1): 16-24
https://doi.org/10.69149/orthopedics/2026v18iss1_2

Received: 28 November 2025 Accepted: 7 January 2026

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Abstract

Modic type I changes represent an active form of vertebral osteochondrosis characterized by a subchondral inflammatory microenvironment and are strongly associated with clinically relevant chronic low back pain. In this setting, vertebrogenic pain cannot be attributed solely to mechanical factors; rather, it reflects the interaction among inflammation, oxidative stress, and extracellular matrix (ECM) dysfunction. To present two clinical cases of chronic low back pain associated with Modic type I changes and to discuss the biological rationale and potential clinical benefit of a combined and sequential therapeutic approach based on oxygen-ozone therapy and injectable porcine collagen. Two observational case reports are described involving patients with chronic low back pain treated according to a six-week protocol alternating CT-guided oxygen-ozone therapy and paravertebral infiltrations of injectable collagen (MD-Lumbar). The approach was designed to modulate the vertebrogenic inflammatory component and support the myofascial and connective tissue compartments involved in chronic pain. At the end of the treatment cycle, both patients showed a marked reduction in pain symptoms and a significant functional recovery, with stabilization of clinical benefit at follow-up. The treatment was well tolerated, with no clinically relevant adverse events. These cases suggest that the combined use of oxygen-ozone therapy and injectable collagen may represent a biologically coherent and potentially effective therapeutic strategy for the management of low back pain associated with Modic type I changes. Despite the limitations inherent to two case reports, the findings support the interest in integrated redox- and ECM-oriented protocols and warrant further evaluation in prospective controlled studies.

Keywords: extracellular matrix modulation, injectable type I collagen, Modic type I changes, oxygen-ozone therapy, vertebrogenic low back pain