title: Single intradiscal injection of the interleukin-6 receptor antibody tocilizumab provides short-term relief of discogenic low back pain; prospective comparative cohort study.
abstract: BACKGROUND
  Inflammatory cytokines, such as interleukin-6 and tumor necrosis factor-α, are gaining attention as important etiologic factors associated with discogenic low back pain. We conducted a prospective cohort study to evaluate the efficacy and safety of intradiscal injection of the interleukin-6 receptor antibody tocilizumab in patients with discogenic low back pain.
  
  
  METHODS
  Thirty-two consecutive patients were intradiscally injected with 2 mL of 0.5% bupivacaine (control group). Another 31 consecutive patients were intradiscally injected with 40 mg tocilizumab and 1-2 mL of 0.5% bupivacaine (tocilizumab group) at the same time. Prior to treatment, the vertebral origin of low back pain was confirmed in all patients based on pain provocation during discography and pain relief with 1 mL of 1% xylocaine. Numeric rating scale and Oswestry disability index scores were used to evaluate pain level before and after treatment between the 2 groups. The association between pain relief with tocilizumab and intervertebral disc degeneration grade was also determined.
  
  
  RESULTS
  At the end of the study (8 weeks after treatment), 30 patients in each group were evaluable. In the tocilizumab group, numeric rating scale and Oswestry disability index scores improved significantly at 2 and 4 weeks after treatment, respectively. Intervertebral disc degeneration was not associated with improvement of numeric rating scale score in the tocilizumab group. Local infection (i.e., discitis) was observed in 1 patient in the tocilizumab group.
  
  
  CONCLUSIONS
  The results demonstrate the clinical relevance of interleukin-6 in discogenic low back pain. Intradiscal tocilizumab injection was shown to exert a short-term analgesic effect in patients with discogenic low back pain. Further research is required to determine the long-term effects of intradiscal tocilizumab therapy in patients with discogenic low back pain.
authors.affiliation: Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan. Electronic address: sain3005@yahoo.co.jp.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Sainoh
authors.affiliation: Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Sumihisa
authors.initials: S
authors.lastname: Orita
authors.affiliation: Department of Orthopaedic Surgery, Kitasato University, Kanagawa, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Miyagi
authors.affiliation: Department of Orthopaedic Surgery, Kitasato University, Kanagawa, Japan.
authors.forename: Gen
authors.initials: G
authors.lastname: Inoue
authors.affiliation: Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Kazuyo
authors.initials: K
authors.lastname: Yamauchi
authors.affiliation: Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Miyako
authors.initials: M
authors.lastname: Suzuki
authors.affiliation: Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sakuma
authors.affiliation: Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Go
authors.initials: G
authors.lastname: Kubota
authors.affiliation: Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Oikawa
authors.affiliation: Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Inage
authors.affiliation: Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Sato
authors.affiliation: Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Nakata
authors.affiliation: Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Chiba, Japan.
authors.forename: Yasuchika
authors.initials: Y
authors.lastname: Aoki
authors.affiliation: Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Takahashi
authors.affiliation: Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Ohtori
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D007403:Intervertebral Disc; D055959:Intervertebral Disc Degeneration / Q000150:complications; D017116:Low Back Pain / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019947:Receptors, Interleukin-6 / Q000276:immunology; D055815:Young Adult
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D019947:Receptors, Interleukin-6; C502936:tocilizumab