Authors

Study name

Study design

Patient population

No. of patients

Treatment groups

Outcomes

Level of evidence**

Cao et al. 2011 [13]

Intradiscal injection therapy for degenerative chronic discogenic low back pain with end plate Modic changes

RCT

Discogenic LBP and end plate
Modic changes (MRI) + discography.

120

Intradiscal injection of saline, diprospan, and diprospan+songmeile.

No significant pain relief within the groups receiving intradiscal saline. The groups that received either diprospan or diprospan + songmeile injections significantly improved their VAS and ODI scores.

1b

Peng et al. 2010 [6]

A randomized placebo-controlled trial of intradiscal methylene blue injection for the treatment of chronic discogenic low back pain

RCT

Discogenic LBP longer than 6 months with no previous lumbar surgery

72

Intradiscal injection of methylene blue and isotonic saline

Mean reduction in NRS-101 of 52.50, and ODI of 35.58. As well as 91.6% patient satisfaction in the MB group vs 0.70%, 1.68%, and 14.3% in the placebo group.

1b

Khot et al. 2004 [8]

The Use of Intradiscal Steroid Therapy for Lumbar
Spinal Discogenic Pain

RCT

Chronic discogenic LBP

120

Intradiscal injection of methylprednisolone and saline

No difference in outcomes measures (disability and pain scores) at 12 months

1b

Beall et al. 2020 [9]

VAST Clinical Trial: Safely Supplementing Tissue Lost to Degenerative Disc Disease

RCT

Disc degeneration at 1 or 2 vertebral levels from L1 to S1 with chronic low back pain for a minimum of 6 months

220

Allograft, saline or continue nonsurgical management (NSM)

VAS improved at 6 months from 54.81 to 16.0 on the allograft group and from 55.25 to 41 in the saline group. At 12 months the allograft decreased to 12.27 and in the saline group decreased to 19.67. ODI from 53.73 and 49.25 in the allograft and saline respectively to 18.47 at 6 months and 28.75 at 12 months in the allograft group. Saline group: 15.67 and 9.33 at 6 and 12 months, respectively.

1b

Kallewaard et al. 2019 [7]

A multicenter randomized controlled trial on the efficacy of intradiscal methylene blue injection for chronic discogenic low back pain: the IMBI study

Double-blinded RCT

Chronic discogenic low back pain for at least 6 months with poor response to conservative therapy

84

Intradiscal injection of methylene blue and isotonic saline

NRS between the groups was statistically insignificant after 6 months with no change in the PGIC

1b

Nguyen et al. 2017 [26]

Intradiscal glucocorticoid injection for patients with chronic low back pain (LBP) associated with active discopathy

Double-blinded RCT

Chronic lower back pain for at least 3 months with discopathy on MRI

135

glucocorticoids and iodixanol contrast vs iodixanol contrast alone

At 1 month 11-point NRS was higher in the GC IDI (55.4%) vs control (33.3%), the improvement of LBP-related limitation improved in the GC IDI group (84.6% VS 54.0%). At 3 months pain scores in the GC IDI were higher than in the control and by 12 months, there were not differences between the 2 groups

1b

Schwetschenau et al. 1976 [10]

Double-blinded evaluation of intradiscal chymopapain for herniated lumbar disc

Double-blinded RCT

LBP with radiculopathy and no improvement after 3 months of conservative treatment

66

Chymopapain vs placebo

The successful rate for the chymopapain group was 58% and for the placebo group was 49%, with a p value of 0.14

1b

Bae et al. 2014 [12]

Is there clinical improvement associated with saline injection for discogenic low back pain: comparison of RCTs

Post-hoc comparison of RCT

N/A

N/A

Intervertebral disc injection of saline vs investigational drug

At 12 months: saline patients had a 58.5% decreased in VAS vs 36.6% decreased for the investigational group

1a