Miller S, Caragea M, Carson D, McFarland MM, Teramoto M, Cushman DM, Cooper AN, Burnham T, McCormick ZL, Conger A. The effectiveness of intradiscal corticosteroid injection for the treatment of chronic discovertebral low back pain: a systematic review.
PAIN MEDICINE (MALDEN, MASS.) 2024;
25:33-46. [PMID:
37740319 PMCID:
PMC11494378 DOI:
10.1093/pm/pnad127]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/03/2023] [Accepted: 08/21/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVE
Determine the effectiveness of intradiscal corticosteroid injection (IDCI) for the treatment of discovertebral low back pain.
DESIGN
Systematic review.
POPULATION
Adults with chronic low back pain attributed to disc or vertebral end plate pain, as evidenced by positive provocation discography or Modic 1 or 2 changes on magnetic resonance imaging.
INTERVENTION
Fluoroscopically guided or computed tomography-guided IDCI.
COMPARISON
Sham/placebo procedure including intradiscal saline, anesthetic, discography alone, or other active treatment.
OUTCOMES
Reduction in chronic low back pain reported on a visual analog scale or numeric rating scale and reduction in disability reported by a validated scale such as the Oswestry Disability Index.
METHODS
Four reviewers independently assessed articles published before January 31, 2023, in Medline, Embase, CENTRAL, and CINAHL. The quality of evidence was evaluated with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. The risk of bias in randomized trials was evaluated with the Cochrane Risk of Bias tool (version 2).
RESULTS
Of the 7806 unique records screened, 6 randomized controlled trials featuring 603 total participants ultimately met the inclusion criteria. In multiple randomized controlled trials, IDCI was found to reduce pain and disability for 1-6 months in those with Modic 1 and 2 changes but not in those selected by provocation discography.
CONCLUSION
According to GRADE, there is low-quality evidence that IDCI reduces pain and disability for up to 6 months in individuals with chronic discovertebral low back pain as evidenced by Modic 1 and 2 changes but not in individuals selected by provocation discography.
STUDY REGISTRATION
PROSPERO (CRD42021287421).
Collapse