Intradiscal Glucocorticoid Injection in Discogenic Back Pain and Influence on Modic Changes: A Systematic Review and Meta-analysis of RCTs.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2024;12(7):26 Pain Physician . 2023 Sep;26(5):E449-E465.What this means for my practice?
Clinicians should consider intradiscal glucocorticoid injection during early-phase treatment for short-term relief in discogenic low back pain and physical function. These benefits are sustained in the intermediate term up to 6 months, upon which outcomes become similar to the control. However, the long-term benefits are inconclusive. Patients with or without Modic type I changes may benefit from IGI. Lastly, the study's limitations, including the limited number of studies and heterogeneity, should be acknowledged for comprehensive clinical decision-making.
Study Summary
Seven randomized controlled trials involving 626 patients with discogenic low back pain (LBP) were included in this systematic review and meta-analysis comparing intradiscal glucocorticoid injection (IGI; Treatment A, n=314) against a control group (Treatment B, n=312). Pooled outcomes of interest included pain intensity scores, physical function via Oswestry Disability Index (ODI), and incidence of pain improvement. Overall, the IGI group was associated with a significantly lower pain intensity at short term follow up (<3 months). Physical function outcomes were significantly in favour of the IGI group at both short-term and intermediate follow up. No differences in any of the outcomes were observed at long-term follow-up. These results suggest that IGI could provide significantly greater symptom improvement and improved physical function for patients with discogenic LBP compared to control interventions, especially during early phase treatment as outcomes become comparable at 6 months between groups.
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