A Case Review of Intradiscal Depomedrol and Bupivicaine for Treating Refractory Spine Pain

Harold A. Wilkinson, MD
Edward Akeyson, MD, PhD
James Lin, Jr, BS

Introduction:

Depomedrol has been injected intradiscally for 50 years, yet its use remains controversial. The few published studies have claimed favorable results, but none were recent.

Methods:

A case review from the senior author's patients undergoing lumbar or cervical intradiscal steroid injections for diagnosis and treatment of axial spine pain. 80 mg (1 ml) of Depomedrol was injected at the conclusion of diagnostic discography. Anesthesia discography results were quantitated as short term relief from axial spine pain spontaneously and on motion, and results of intradiscal therapy as longer term relief. 84 lumbar and 32 cervical injections between January, 1993 and December, 1997 were analyzed.

Results:

The lumbar cohort included 38% females/62% males, average age 38 years. Outcomes were poorer with severe focal disk space degeneration, but there was little difference with age, normal versus abnormal isotope scans or primary versus postoperative disk degeneration. Poor pain relief from anesthesia discography predicted a poorer response to intradiscal therapy. Overall 39% obtained a good or excellent response to intradiscal therapy (median 2 months, average 4.9 months). In the cervical cohort there were 61% females and only 39% males, average age 45 years. Outcomes of intradiscal therapy were worst with only mild focal disk degeneration or primary disk degeneration. The results of intradiscal therapy were generally better in these cases: 41% good or excellent responses (median 6 months, average 10.0 months). Repeated injections gave better results, and those with good/excellent results were less likely to undergo later spine fusion.

Conclusions:

Intradiscal steroid therapy can be useful in the treatment of axial spine pain.