Biochemical injection treatment for discogenic low back pain: a pilot study.
BACKGROUND
Biochemical treatment options including attempts at intervertebral disc restoration are desirable for the physiologic treatment of degenerative disc disease.


OBJECTIVE
This was a pilot study to test the potential effectiveness of intradiscal injection therapy using agents known to induce proteoglycan synthesis in the treatment of intervertebral disc disease.


METHODS
Prospective, within subject, experimental design was applied in the study.


METHODS
Thirty patients, average age 46.5 years, with chronic intractable low back pain of 8.5 years average duration, took part in the study. All patients had lumbar discography with reproduction of pain.


METHODS
Pretreatment Roland-Morris disability scores and visual analogue scores were compared with 1-year follow-up posttest values of these scores.


METHODS
Lumbar intervertebral discs were injected with a solution of glucosamine and chondroitin sulfate combined with hypertonic dextrose and dimethlysulfoxide (DMSO). Assessment of pain and disability was completed before treatment and an average of 12 months after the last treatment.


RESULTS
Posttreatment Roland-Morris scores for the entire group of 30 patients of 6.4+/-.994 were significantly (p<.001) lower than pretreatment scores of 12.0+/-.92 (mean+/-SE). The posttreatment visual analogue scores of 3.00+/-.44 were also significantly less than the pretreatment of 6.11+/-.33 (mean+/-SE). Although the results were statistically significant for the 30 patients as a whole, 17 of the 30 patients (57%) improved markedly with an average of 72% improvement in disability scores and 76% in visual analogue scores. The other 13 patients (43%) had little or no improvement. Patients who did poorly included those with failed spinal surgery, spinal stenosis and long-term disability. There were no complications or serious side effects, although postinjection pain was moderate to severe for 48 to 72 hours and required epidural steroids in five cases.


CONCLUSIONS
The results of this pilot study suggest that intradiscal injection therapy with glucosamine, chondroitin sulfate, hypertonic dextrose and DMSO warrants further evaluation with randomized controlled trials.
Klein
Robert G
RG
Orthopedic Medicine, 2927 De La Vina, Suite D, Santa Barbara, CA 93105, USA. RKlein42@aol.com
Eek
Björn C J
BC
O'Neill
Conor W
CW
Elin
Caren
C
Mooney
Vert
V
Derby
Richard R
RR
D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage*; D002809:Chondroitin Sulfates / Q000008:administration & dosage*; D004121:Dimethyl Sulfoxide / Q000008:administration & dosage*; D005260:Female; D005944:Glucosamine / Q000008:administration & dosage*; D005950:Glucose Solution, Hypertonic / Q000008:administration & dosage*; D006801:Humans; D007278:Injections, Spinal / Q000009:adverse effects; D007405:Intervertebral Disc Displacement / Q000150:complications*; D017116:Low Back Pain / Q000188:drug therapy* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D010865:Pilot Projects; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D018712:Analgesics, Non-Narcotic; D005950:Glucose Solution, Hypertonic; D002809:Chondroitin Sulfates; D005944:Glucosamine; D004121:Dimethyl Sulfoxide