Intradiscal steroid therapy in chronic discogenic pain: a systematic review of literature

Abstract

Background: This article aims to conduct a systematic review of the present literature and assess the use of intra-discal steroids injection (IDSI) for patients suffering from chronic discogenic back pain irresponsive to conservative treatment. Methods: The search was conducted in PubMed, PubMed Central, Cochrane, Scopus, Embase, and Google Scholar databases between 1990 and 2021. Included were studies assessing the administration of IDSI to adults suffering from chronic discogenic back pain. Studies evaluating combination interventions were excluded. The quality of evidence was determined by the GRADE assessment. The PROSPERO registration number for the review is CRD42022307690. Results: Eight studies enrolling a total of 548 patients were finally included in the systematic review. A significant reduction in pain scores after IDSI was calculated one month after intervention [standardized mean difference (SMD) −1.32 (−2.32, −0.31), p = 0.01, I2 = 89%]. This effect was not sustained at three- six- and twelve-month assessments. The analysis revealed no therapeutic benefit of intra-discal steroids for disability and activity limitation at one month, [SMD −0.76 (−1.88, 0.36), p = 0.18, I2 = 92%], three-, six- or twelve-months intervals. Overall, the quality of effect estimates was found to be moderate. Conclusions: The authors believe that Intradiscal steroid therapy can only be used as a bridge therapy for short-term pain relief while the patient with chronic discogenic pain awaits another intervention or surgery.