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Neck Ozone Injection Protocol
Cervical landmarks, levels to avoid and the needle for ozone neck injections, with the Prolozone mixture and ozone-oxygen approaches side by side.
Quick answer: Ozone neck injection uses cervical levels C4–5 and C6–7 with a 27G × 1.5 in needle (Wright). Madrid lists 5 mL at 10–20 µg/mL. The sheet also covers the levels to avoid.
Warning
Requires hands-on training from an experienced physician
Neck ozone injection should only be performed by a practitioner trained in it by an experienced physician.
Practitioner-only procedure. Injecting ozone, with or without a nutrient mixture, is done by trained, licensed clinicians. This sheet is a reference for them. It is not a self-treatment guide and not medical advice. Strict sterile technique is required every time.
What are the basics of ozone neck injection?
- Wright's neck injections are between the spinous processes at C6–7 (just above C7) and C4–5 (just above C5). He does not go above C4.
- Madrid describes cervical paravertebral injection 1.5 cm to the side of the spinous process, and a longer-needle facet technique. Those are different entry points from Wright's.
- Prolozone, as Dr. Jeff Wright teaches it, adds nutrients and ozone to damaged tissue. His explanation: swollen tissue receives less blood, which leaves the area short of oxygen, and ozone supplies bioavailable oxygen.
- Wright's expected course from his own practice: a second injection 10 to 14 days after the first, with results after as few as 3 injections or as many as 6 to 8. Chronically ill patients can need more. He describes his success as 90 to 95 percent. That is his clinical impression, not a trial result.
- Wright's tutorials do not state ingredient amounts. The solution he used is a compounded pre-mix of methylcobalamin (vitamin B12), pyridoxine (vitamin B6), dextrose and procaine. The amounts are in the table below, taken from the compounded formula sheet. He also describes drawing up individual nutrients in a hood.
- The Madrid Declaration describes ozone-oxygen infiltration only: no nutrient mixture. Both are shown side by side below and labeled.
Sources: Dr. Jeff Wright's tutorial videos for MediSkill; Madrid Declaration on Ozone Therapy, 4th edition (ISCO3, 2025), sections 1.12 and 4. Paraphrased.
What dose and technique are used for ozone neck injection?
Two approaches are shown side by side. They are different procedures: the Prolozone mixture is Wright's, and ozone-oxygen alone is what Madrid describes.
| Prolozone mixture (per Wright) | Ozone-oxygen only (per Madrid) | |
|---|---|---|
| What goes in | Dr. Wright's pre-mixed solution (formula below) first, then ozone gas, at each level. | Ozone-oxygen mixture. Optional local anesthetic, placed above the ozone injection so it does not oxidize (oxidized anesthetic causes an intense burning sensation). |
| Gas volume | Not stated. The patient says when they feel full; Wright stops when they feel enough pressure. | Paravertebral: 5 mL (section 4.2). Facet or hernia: 3 to 5 mL (section 4.3). |
| Concentration | Not stated in the tutorial. | 10 to 20 µg/mL. |
| Entry point | Midline, between the spinous processes, at a slight angle matching the angle of the spinous processes. | Paravertebral: 1.5 cm lateral to the spinous process. Facet: closer to the laminae, foramen or around the facet joint. |
| Needle | 27-gauge by 1.5-inch, to avoid going too deep. | Paravertebral: 27G, 0.4 by 19 mm. Facet or hernia: spinal needle 0.4 or 0.5 mm by 90 mm. |
| Schedule | Second injection 10 to 14 days after the first. Results in as few as 3 and as many as 6 to 8 injections. | Not specified for the neck. |
Dr. Wright's pre-mixed solution: how it is made (per 8 mL of mixture)
This is the compounded mixture Dr. Wright used in his protocols. The amounts below are the recipe for making the mixture, taken from the compounded formula sheet, not from the tutorial videos. They are not the amount injected at one site.
| Ingredient | Strength | Amount per 8 mL of mixture |
|---|---|---|
| Methylcobalamin (methyl-B12) | 1 mg/mL | 2 mL |
| Pyridoxine (vitamin B6) | 100 mg/mL | 1 mL |
| Dextrose | 50% | 1 mL |
| Procaine | 2% | 4 mL |
| Total | 8 mL |
- Draw up the solution into a sterile syringe using antiseptic technique (the formula sheet uses a 10 mL syringe).
- Inject the solution at the selected site, using this sheet's own technique and volume.
- Leave the needle in place, remove the syringe, and inject the ozone through the same needle.
How much is injected is not stated in Dr. Wright's neck tutorial, so this sheet gives no solution volume.
This is a compounded pre-mix with a beyond-use date of 90 days refrigerated. The solution is compounded by a pharmacy and requires a prescriber.
Madrid advises placing any local anesthetic so that the ozone does not break it down. Dr. Wright gives his solution first and then the ozone through the same needle. These are two different practices.
Madrid's paravertebral schedule for the back (twice a week for two weeks, then spaced out) is on the back injection sheet. It does not give a separate neck schedule.
What are the best tips when using ozone neck injection?
- Find C7 first, then C6, then count up to C5 and C4.
- If you cannot push fluid in, you are against a place that will not allow it. Adjust until there is a sweet spot where the fluid goes in.
- If you hit a spinous process, back out a little, reposition and inject again.
- Tell the patient what to expect. Pressure and fullness while the gas goes in are normal, and the patient should say when it is too much. Wright says an electrical zing is not normal: stop and reposition.
What are the precautions for ozone neck injection, and who should avoid it?
- Sterile technique every time. Madrid says most serious side effects trace back to malpractice, including technique, asepsis and antisepsis. Its reported serious events include septic arthritis of the knee after intra-articular infiltration, abscess after paravertebral injection, and one death from sepsis after a paravertebral infiltration done without proper asepsis (Madrid Declaration on Ozone Therapy, 4th edition (ISCO3, 2025), section 2.5).
- Clean the injection site with alcohol and let it dry before the needle goes through (as Dr. Wright does). Use sterile, single-use syringes and needles, and do not touch the vial adapter once it is out of its package (Wright).
- Draw up nutrient solutions in a hood with needleless vial adapters, as Dr. Wright demonstrates in his overview video. Check that every solution you inject is allowed by your licensing board, as he advises.
- Never inject ozone gas into a vein or an artery. Madrid strongly discourages both because of the risk of air embolism, and lists embolic events after paravertebral and intradiscal injections among its serious adverse events.
- Do not go above the fourth cervical vertebra. Wright's reasons: the spinal cord must be avoided, and the upper neck has many cranial and other nerves. He does not go near it.
- Wright notes C4 and C5 sit together unusually, with C4 tapering more, leaving a smaller opening there.
- Madrid's reported serious events after paravertebral infiltration include a multifocal stroke from air emboli, posterior reversible encephalopathy syndrome, and massive emphysema with pneumomediastinum. Never inject gas into a vessel.
Contraindications
The Madrid Declaration lists these contraindications for systemic ozone (IV and blood). It gives no separate list for paravertebral injection, but many practitioners use the same screening before treating:
- Direct inhalation of ozone gas. The fluid lining the lungs has no antioxidants to buffer it, so inhaled ozone is toxic.
- Glucose-6-phosphate dehydrogenase (G6PD) deficiency (favism, acute hemolytic anemia). Madrid lists it as a contraindication for systemic ozone, but whether it is absolute is debated. MediSkill protocols start low and go slow; see the contraindications article.
- Toxic hyperthyroidism (severe Graves' disease)
- Thrombocytopenia (platelets under 50,000) and severe coagulation disorders
- Severe cardiovascular instability
- Acute alcohol intoxication
- Recent acute myocardial infarction
- Acute massive hemorrhage
- Convulsive states
- Hemochromatosis
- Patients receiving intravenous copper or iron therapy
Pregnancy. Madrid advises avoiding ozone therapy in the first trimester (weeks 0 to 13) and reserves its use in pregnancy for specialists in gynecology and obstetrics.
More detail
Landmarks and steps, as demonstrated by Dr. Wright
- Find the spinous process of C7, then C6. Mark just above C7 for the first injection.
- Find C5. Mark just above C5 for the second injection (C4–5).
- Clean the sites with alcohol. Use the 27-gauge, 1.5-inch needle.
- Insert between the spinous processes at a slight angle matching the spinous processes. Anchor the syringe.
- Push in the fluid; adjust if it will not go.
- Inject the gas and ask the patient to say when they feel full. Stop there. Repeat at the second level.
Equipment
- 27-gauge by 1.5-inch needle and sterile syringes
- Dr. Wright's compounded pre-mixed solution (requires a prescriber), or individual nutrients drawn up in a hood with needleless vial adapters
- Ozone-oxygen gas in a syringe
- Alcohol prep; imaging guidance where precision matters
What the studies used
Study doses are listed as printed in each paper and are not Madrid or Wright dosing.
- In a 76-person series of chronic neck pain and low back pain, the cervical protocol used 3 to 5 mL of ozone through a 25G needle, twice weekly for 12 sessions. The paper's reported pain outcome in our summary is for low back (NRS 6.4 to 3.2 at 6 months, no control group) (Latini 2024).
- In 45 people with myofascial neck pain, ozone at 10 µg/mL, 5 mL per trigger point, weekly for 3 weeks, helped, but pain improved more with lidocaine (interaction p=0.028) (Korkmaz 2023). This was trigger-point injection, not the interspinous technique on this sheet.
Neck evidence is thin: the study summary we drew on has no controlled trial of cervical ozone injection by the Wright technique. No human study of the classic Prolozone mixture (procaine, vitamins and ozone) is in the study summary we drew on. Trials that add something to ozone used dextrose, somatropin or hypertonic saline, and the evidence for Wright's mixture itself rests on his clinical experience.
Video
Overview of the technique and the reasoning behind it: Prolozone Overview - Ozone Joint Injections | Dr. Jeff Wright.
Learn more
Background, benefits and research on injections: Ozone injections, full article.
Related protocols: Back Ozone Injection Protocol, Trigger Point Ozone Injection Protocol, Acupuncture Point Ozone Injection Protocol.
Other injection protocols
For licensed practitioners. Educational reference only, not medical advice. Follow your scope of practice and local regulations.
