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 (CLBP) attributed to disc or vertebral endplate pain as evidenced by positive provocation discography or Modic 1 or 2 changes on MRI.
INTERVENTION: Fluoroscopically or CT-guided IDCI.
COMPARISON: Sham/placebo procedure including intradiscal saline, anesthetic, discography alone, or other active treatment.
OUTCOMES: Reduction in CLBP reported on Visual Analog Scale (VAS) or Numeric Rating Scale (NRS) and reduction in disability reported by validated scale such as Oswestry Disability Index (ODI).
METHODS: Four reviewers independently assessed publications before January 31, 2023 in Medline, Embase, CENTRAL, and CINAHL. The quality of evidence was evaluated using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) framework. The risk of bias in randomized trials was evaluated using the Cochrane Risk of Bias tool (V2).
RESULTS: Of the 7806 unique records screened, six randomized controlled trials (RCTs) featuring 603 total participants ultimately met inclusion. In multiple RCTs, IDCI was found to reduce pain and disability between one and six 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 in individuals with chronic discovertebral LBP as evidenced by Modic 1 and 2 changes for up to six months, but not in those selected by provocation discography.