• Martin Riegger, Huyen Le, van KuijkSander M JSMJPain Management Center, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland; Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, the Netherlands., Gabor Guyenes, Christian Candrian, Alessandro Cianfoni, Joshua A Hirsch, and Eva Koetsier.
• Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.
• Pain Physician. 2023 Sep 1; 26 (5): E449E465E449-E465.

BackgroundThe benefit of intradiscal glucocorticoid injection (IGI) for discogenic low back pain (LBP) remains controversial.ObjectivesThe objective of this study was to systematically assess and meta-analyze the efficacy of IGI compared with these control groups.Study DesignSystematic review and meta-analysis.MethodsA comprehensive literature search was performed screening PubMed and Embase through May 2022. Only randomized controlled trials (RCTs) comparing IGI to control groups in adult patients with discogenic lumbar back pain were included. A random effects model was used to pool mean differences of pain intensity (visual analaog scale [VAS] 0-100), and physical function assessed with the Oswestry Disability Index (ODI). Subgroup analyses were stratified by Modic magnetic resonance imaging findings.ResultsSeven studies met inclusion criteria with a total of 626 patients. The short-term (< 3 months) follow-up showed a significant pooled mean difference in both pain intensity (-20.1; 95% CI, -25.5 to -14.7) and physical function (-9.9; 95% CI, -16.1 to -3.6). In the intermediate -term follow-up (3 to < 6 months), only physical function remained significantly better in the glucocorticoid group (-13.1; 95% CI, -22.3 to -3.9). There was no clinically meaningful or significant difference in pain scores and physical function at the long-term (>= 6 months) follow-up. A subgroup analysis did not demonstrate an effect of Modic (type I) changes on the efficacy of IGI.LimitationsA limited number of studies was available and consequently publication bias could not be evaluated using a funnel plot. Statistical heterogeneity was detected among the included studies.ConclusionWe conclude that IGI reduces discogenic LBP intensity and improves physical function effectively at short-term follow-up, and continues to improve physical function at intermediate-term. However, 6 months posttreatment, outcomes are similar in comparison to the control groups. The type of Modic change does not appear to be related with the response to IGI.Key WordsLow back pain, lumbar back pain, intradiscal glucocorticoid injection, modic changes, meta-analysis.

19 keywords...

hide…