Immunological Considerations and Biological Consequences of Intradiscal Needle Procedures: Implications for Chemo-Nucleolysis and Oxygen-Ozone Therapy.

Intervertebral disc (IVD) procedures, including chemo-nucleolysis and oxygen-ozone therapy (OOT), are increasingly used as minimally invasive approaches for disc herniation and radiculopathy. Although generally considered safe, these interventions may induce biological and immunological consequences that remain insufficiently characterized. This editorial discusses the immunobiology of the nucleus pulposus (NP) and the potential effects of annular disruption caused by intradiscal needle procedures. Under physiological conditions, the NP behaves as a relatively immune-privileged tissue because of its avascular structure, extracellular matrix composition, and local immunomodulatory mechanisms. Mechanical disruption of the annulus fibrosus may expose NP-derived antigens and damage-associated molecular patterns (DAMPs) to immune surveillance, activating inflammatory pathways involving Toll-like receptors, NF-κB signalling, inflammasomes, cytokine release, oxidative stress, and extracellular matrix degradation. Although chemo-nucleolysis and OOT may reduce intradiscal pressure and alleviate symptoms, current evidence does not demonstrate restoration of annular integrity or complete recovery of disc immune privilege. A deeper understanding of IVD immunobiology may improve patient selection, procedural safety and long-term therapeutic strategies in minimally invasive spine care.