Intradiscal injection for the management of low back pain

JOR Spine, 2022 · DOI: 10.1002/jsp2.1186 · Published: January 1, 2022

Pain Management Orthopedics Regenerative Medicine & Stem Cells

Simple Explanation

Low back pain (LBP) is a widespread problem causing physical disability and socioeconomic burden. Intervertebral disc degeneration (IDD) is a major cause. Current treatments for LBP have limited efficacy because they don't fix the degeneration. New therapies use intradiscal injections to target the cause of the disease for pain relief and disc repair. This review looks at the potential and limitations of different medications and biological reagents used in intradiscal injections for treating LBP, based on clinical trials and systematic reviews.

Study Duration

Not specified

Participants

Nearly 8000 patients (in a meta-analysis)

Evidence Level

Systematic reviews, meta-analyses, RCTs

Key Findings

1
Intradiscal injection is a minimally invasive outpatient procedure that can improve pain quality for patients with LBP or lumbar disc herniation (LDH).
2
Mesenchymal stem cells (MSCs) may be a potential therapeutic strategy for early disc degeneration due to their immunomodulatory properties.
3
Platelet-rich plasma (PRP) has shown beneficial effects in controlling pain and improving disabilities in patients with LBP.

Research Summary

Intradiscal injection is a minimally invasive technique used for low back pain, with its safety and effectiveness supported by clinical trials. Various medications and biological agents are used, but their efficacy is hard to compare due to different study designs. There is insufficient evidence to support strong recommendations. Combined injections, especially cell therapy and tissue engineering, may be ideal for restoring disc function and regeneration, but more clinical data is needed.

Practical Implications

Personalized Treatment

The review highlights the importance of selecting appropriate medications or biological reagents for intradiscal injection based on the specific underlying pathology of the patient's low back pain.

Future Research

Further high-quality clinical trials are needed to confirm the efficacy of intradiscal injections, particularly for treatments like PRP and condoliase.

Combined Therapies

The potential of combining cell therapy with tissue engineering technology offers a promising avenue for future research and development of more effective treatments for intervertebral disc degeneration.

Study Limitations

1
Efficacy of glucocorticoids, methylene blue, and cytokine inhibitors is difficult to maintain for a long period due to their half-lives.
2
It is difficult for the implanted MSCs to maintain their viability in the hypoxic and acidic environment of the degenerated disc.
3
Current research on hydrogel-based biomaterials is mainly conducted in vitro and animal experiments; the safety and feasibility of this option still need to be confirmed by more clinical studies.

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