Intervertebral disc therapies for non-specific chronic low back pain: a systematic review and meta-analysis

Abstract

Objectives: We aim to evaluate the benefits and harms of intervertebral disc therapies (IDTs) in people with non-specific chronic low back pain (NScLBP). Methods: We conducted a systematic review and meta-analysis of randomized trials of IDTs versus placebo interventions, active comparators or usual care. EMBASE, MEDLINE, CENTRAL and CINHAL databases and conference abstracts were searched from inception to June 2020. Two independent investigators extracted data. The primary outcome was LBP intensity at short term (1 week–3 months), intermediate term (3–6 months) and long term (after 6 months). Results: Of 18 eligible trials (among 1396 citations), five assessed glucocorticoids (GCs) IDTs and were included in a quantitative synthesis; 13 assessed other products including etanercept ( n = 2), tocilizumab ( n = 1), methylene blue ( n = 2), ozone ( n = 2), chymopapaine ( n = 1), glycerol ( n = 1), stem cells ( n = 1), platelet-rich plasma ( n = 1) and recombinant human growth and differentiation factor-5 ( n = 2), and were included in a narrative synthesis. Standardized mean differences (95% CI) for GC IDTs for LBP intensity and activity limitations were −1.33 (−2.34; −0.32) and −0.76 (−1.85; 0.34) at short term, −2.22 (−5.34; 0.90) and −1.60 (−3.51; 0.32) at intermediate term and −1.11 (−2.91; 0.70) and −0.63 (−1.68; 0.42) at long term, respectively. Odds ratios (95% CI) for serious and minor adverse events with GC IDTs were 1.09 (0.25; 4.65) and 0.97 (0.49; 1.91). Conclusion: GC IDTs are associated with a reduction in LBP intensity at short term in people with NScLBP. Positive effects are not sustained. IDTs have no effect on activity limitations. Our conclusions are limited by high heterogeneity and a limited methodological quality across studies. Registration PROSPERO: CRD42019106336.

Chronic Low Back Pain: A Narrative Review of Recent International Guidelines for Diagnosis and Conservative Treatment

“…There are published data that reported the efficacy of glucocorticoid intradiscal injections for people with chronic LBP and active discopathy (Modic 1 changes) [ 30 , 31 , 32 ], confirming the significance of Modic 1 changes as an imaging biomarker of a painful intervertebral disc when considered with clinical and biological biomarkers [ 33 , 34 ]. This may serve as a model of validation for phenotypes in people with LBP, and the phenotyping assistance provided by MRI [ 5 ].…”

Image-Guided Minimally Invasive Treatment Options for Degenerative Lumbar Spine Disease: A Practical Overview of Current Possibilities

“…Image-guided procedures are considered minimally invasive treatments for LBP, after failure of conservative therapy [ 44 ]. Overall, minimally invasive treatments are far less expensive than surgery and produce good results, as demonstrated in some meta-analyses [ 45 , 46 , 47 ].…”

Therapeutische Injektion und Manuelle Medizin beim tiefen Rückenschmerz

“…Die intradiskalen Interventionen (IDT) mit GK und PRP („platteled enriched plasma“) sind in den Hintergrund geraten, da die nur kurzfristigen positiven schmerzhemmenden Effekte den vergleichsweise hohen Prozedurenaufwand im Ergebnis nicht rechtfertigen [ 22 , 64 ]. Die intradiskalen Ablationen bewirken oftmals aufgrund der iatrogenen Gewebeschädigung einen Progress der Diskopathie mit all deren das gesamte Segment betreffenden möglichen Folgen (s. oben).…”