Patients and methods: This retrospective study reviewed the files of 120 patients (60 males, 60 females; mean age: 48.5±12.0 years; range, 18 to 75 years) who underwent fluoroscopy-guided transforaminal epidural steroid or steroid plus ozone injection between June and December 2020. The patients` clinical and demographic information were noted. Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores were recorded at baseline and one, three, six, and 12 months after the procedure. MacNab scores were evaluated at baseline and 12 months. Postprocedure outcomes were compared with baseline and between the two groups.

Results: Patient characteristics were similar, and both treatment groups showed significant differences in mean VAS and ODI scores compared to baseline (p<0.001). However, the results showed a greater decrease in the combination therapy group (p<0.001). The mean ODI scores were comparable at one, three, and six months but differed at 12 months, with more favorable outcomes in patients who received additional ozone. After a prolonged observation, 61.6% of patients received steroid injections and 78.3% of those who underwent combined treatment were satisfied. The long-term follow-up revealed the absence of significant complications in both treatment groups.

Conclusion: Transforaminal injection of steroid alone and its combination with ozone were both effective in short- and long-term pain and disability. Additionally, ozone had a moderate effect on the results. Therefore, combining steroids and ozone could be a complementary treatment for better outcomes. Keywords : Epidural, injections, low back pain, ozone, steroids