• Takeshi Sainoh, Sumihisa Orita, Masayuki Miyagi, Gen Inoue, Kazuyo Yamauchi, Miyako Suzuki, Yoshihiro Sakuma, Go Kubota, Yasuhiro Oikawa, Kazuhide Inage, Jun Sato, Yukio Nakata, Yasuchika Aoki, Kazuhisa Takahashi, and Seiji Ohtori.
• Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan. Electronic address: sain3005@yahoo.co.jp.
• J Orthop Sci. 2016 Jan 1; 21 (1): 2-6.

BackgroundInflammatory cytokines, such as interleukin-6 and tumor necrosis factor-α, are gaining attention as important etiologic factors associated with discogenic low back pain. We conducted a prospective cohort study to evaluate the efficacy and safety of intradiscal injection of the interleukin-6 receptor antibody tocilizumab in patients with discogenic low back pain.MethodsThirty-two consecutive patients were intradiscally injected with 2 mL of 0.5% bupivacaine (control group). Another 31 consecutive patients were intradiscally injected with 40 mg tocilizumab and 1-2 mL of 0.5% bupivacaine (tocilizumab group) at the same time. Prior to treatment, the vertebral origin of low back pain was confirmed in all patients based on pain provocation during discography and pain relief with 1 mL of 1% xylocaine. Numeric rating scale and Oswestry disability index scores were used to evaluate pain level before and after treatment between the 2 groups. The association between pain relief with tocilizumab and intervertebral disc degeneration grade was also determined.ResultsAt the end of the study (8 weeks after treatment), 30 patients in each group were evaluable. In the tocilizumab group, numeric rating scale and Oswestry disability index scores improved significantly at 2 and 4 weeks after treatment, respectively. Intervertebral disc degeneration was not associated with improvement of numeric rating scale score in the tocilizumab group. Local infection (i.e., discitis) was observed in 1 patient in the tocilizumab group.ConclusionsThe results demonstrate the clinical relevance of interleukin-6 in discogenic low back pain. Intradiscal tocilizumab injection was shown to exert a short-term analgesic effect in patients with discogenic low back pain. Further research is required to determine the long-term effects of intradiscal tocilizumab therapy in patients with discogenic low back pain.Copyright © 2015 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

24 keywords...

hide…