Intradiscal steroids. A prospective double-blind clinical trial.
A prospective, randomized, double-blind study was performed to evaluate the clinical efficacy of intradiscal steroid injections. Criteria for entrance were one-level internal disc disruption or nonsequestered nuclear prolapse with or without sciatica and a positive pain response on awake discography. Exclusion criteria were multilevel disease, central or lateral stenosis, prior lumbar surgery, or medical disease requiring systemic steroids. A total of 25 patients were randomly assigned to Treatment Group A (methylprednisolone, Depo-Medrol 80 mg/ml, The Upjohn Co., Kalamazoo, Michigan) or Treatment Group B (bupivacaine, Marcaine .5% 1.5 ml, Sanofi Winthrop Pharmaceuticals, New York, New York). Fourteen patients received Depo-Medrol, with 21% showing subjective improvement and 79% no improvement; 0% were clinically worse. Eleven patients received intradiscal Marcaine, with 9% showing clinical improvement and 91% no improvement; 0% were clinically worse. To quantify clinical response, a pain diagram grid score, a visual analog scale, and the Oswestry Pain Questionnaire were used before injection and 10-14 days after injection. No statistically significant benefit was identified in the use of intradiscal steroids.
Simmons
J W
JW
Alamo Bone & Joint Clinic, San Antonio, Texas.
McMillin
J N
JN
Emery
S F
SF
Kimmich
S J
SJ
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001416:Back Pain / Q000175:diagnosis; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use; D004311:Double-Blind Method; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000188:drug therapy*; D008775:Methylprednisolone / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000077555:Methylprednisolone Acetate; D010147:Pain Measurement; D011446:Prospective Studies
D000893:Anti-Inflammatory Agents; D000077555:Methylprednisolone Acetate; D008775:Methylprednisolone; D002045:Bupivacaine