Treatment of painful advanced internal lumbar disc derangement with intradiscal injection of hypertonic dextrose.
BACKGROUND
Degenerative discs are thought to produce nerve root pain either mechanically or chemically. Particularly in the case of advanced degenerative disc disease, this clinical entity has often proven to be symptomatically resistant to peridural steroids, Intra-discal Electrothermoplasty (IDET) and direct surgical intervention. Exposure of irritated nerves to hypertonic dextrose is thought to have chemoneuromodulatory potential. Sustained pain reduction has been demonstrated in a pilot study involving injection of a combination of dextrose, glucosamine, chondroitin and dimethylsulfoxide into degenerative discs of patients with chronic low back pain of discogenic origin.


OBJECTIVE
To assess the effects of disc space injections of hypertonic dextrose in patients experiencing chronic advanced degenerative discogenic leg pain, with or without low back pain.


METHODS
Prospective consecutive patient series.


METHODS
Patients with moderate to severe degenerative disc disease without herniation and with concordant pain reproduction with CT discography were included. All had failure of a physical therapy trial and substantial but temporary relief with two fluoroscopically guided epidural steroid injections. Patients underwent bi-weekly disc space injection of a solution consisting of 50% dextrose and 0.25% Bupivacaine in the disc(s) found positive on discography. The study was performed in an out-patient surgery center in the United States. Outcome measures included an 11-scale numeric pain score (0-10).


RESULTS
Each patient was injected an average of 3.5 times. Overall, 43.4% of patients fell into the sustained improvement group with an average improvement in numeric pain scores of 71%, comparing pretreatment and 18 month measurements.


CONCLUSIONS
The results suggest that intradiscal injection of hypertonic dextrose may have a place in the management of pain arising from advanced lumbar degenerative disc disease.
Miller
Matthew R
MR
Lebanon Anesthesia Associates, Pennsylvania, USA. mfbtmiller@verizon.net
Mathews
Robert S
RS
Reeves
K Dean
KD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D005947:Glucose / Q000008:administration & dosage*; D006801:Humans; D007278:Injections, Spinal / Q000379:methods; D007404:Intervertebral Disc Chemolysis / Q000379:methods*; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000188:drug therapy*; D017116:Low Back Pain / Q000188:drug therapy* / Q000209:etiology; D008159:Lumbar Vertebrae / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D012189:Retrospective Studies; D013549:Sweetening Agents / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
D013549:Sweetening Agents; D005947:Glucose