Author reply to critical comments on ultrasound-guided paravertebral oxygen-ozone injections

We reply to the commentary by Franzini et al. regarding our double-blind randomized controlled trial comparing ozone-oxygen injection against pure oxygen for chronic discogenic low back pain. While we welcome scientific discourse, the commentary mischaracterizes key aspects of our methodology and findings. We assert that the use of pure oxygen was a critical innovation designed to isolate the therapeutic effect of ozone from its carrier, addressing a major gap in the literature. Furthermore, we reiterate that our observed clinical improvements (ΔVAS = 5.6) are well above established thresholds for clinical significance. We also clarify that the commentary's extensive theoretical risk model is somewhat disconnected from our empirical safety data (no major adverse events) and the standard practices of mechanistic discussion. We conclude that critique must be data-driven and proportionate to the study's stated aims, and that our trial provides promising data advancing the field of interventional ozone therapy.