Therapeutics and Clinical Risk Management (Oct 2020)
The Technique of Intradiscal Injection: A Narrative Review
Abstract
Alberto Migliore,1 Andrea Sorbino,2 Serenella Bacciu,2 Alberto Bellelli,3 Bruno Frediani,4 Sandro Tormenta,3 Carmelo Pirri,2 Calogero Foti2 1Rheumatology, S. Pietro Fatebenefratelli Hospital, Rome, Italy; 2Physical and Rehabilitation Medicine, University of Rome “Tor Vergata”, Rome, Italy; 3Radiology, Fatebenefratelli S. Pietro Hospital, Rome, Italy; 4Research Centre of Systemic Autoinflammatory Diseases Behcet Disease Clinic and Rheumatology-Ophthalmology Collaborative Uveitis Centre Department of Medical Sciences Surgery and Neurosciences, University of Siena, Siena, ItalyCorrespondence: Andrea Sorbino Email [email protected]: Low back pain (LBP) is one of the most common spine diseases and represents the most frequent cause of absence from work in developed countries. Approximately 40% of chronic LBP is related to discogenic origin. The goal of the study is producing a review of literature to describe analytically the techniques of intradiscal injections.Methods: PubMed database was searched for clinical studies with the different key terms: “intradiscal”, “injection”, “steroid” “procedures”, “techniques”, “CT”, “MRI”, “fluoroscopy”, “fluoroscopic”, “guidance”, “ozone”, “ultrasound”, “images”. Only studies written in English, French, or Italian in which the intradiscal injection represents the main procedure for the low back discopathy treatment on humans were considered. We excluded the articles that do not mention this procedure; those which indicated that the intradiscal injection had happened accidentally during other treatments; those reporting the patient’s pain was determined by other causes than the discopathy (facet joint syndrome, tumor, spondylodiscitis).Results: Thirty-one articles dated from 1969 to 2018 met the criteria. The examined population was 6843 subjects, 52.3% male and 47.7% female, with a mean age of 45.9± 10.1 years. The techniques are highly variable in terms of procedure: different operators, needle guidance, injection sites, drugs, tilt angle of the needle).Conclusion: The efficacy and the safety of the intradiscal procedures are not easily comparable due to different types of studies and their limited number. Further studies are needed to standardize the intradiscal injection technique/procedure to improve safety, repeatability and effectiveness, and last but not least to reduce peri- and postoperative care and health-care costs.Keywords: discopathy, guidance, injection, intradiscal injections, low back pain, safety
