Intradiscal Therapies
Intradiscal Steroids
Studies on intradiscal steroids have shown mixed results, although there is some evidence that non-workers compensation patients with high intensity zones on MRI scan have a beneficial response (1). All of the studies on intradiscal steroids have evaluated the efficacy of the injection as an isolated therapy, rather than as a means to facilitate rehabilitation. Animal data suggests intradiscal methylprednisilone can be harmful (2), secondary to the polyethylene glycol included in the formulation. Therefore, betamethosone is preferred.
(1) Schellhaus paper from NASS meeting.
(2) Aoki, et al. Histologic changes in the Intervertebral Disc after Intradiscal Injection of Methylprednisilone Acetate in Rabbits. Spine 1997;22:2;127-32.
Intradiscal Heating
Intradiscal heating procedures have been proposed for the treatment of lumbar disc disease. Heating procedures done using a radiofrequency technique have also had mixed results. A new procedure, intradiscal electrothermal annuloplasty, has shown promising results in early clinical trials. However, at this point there is no good evidence supporting the routine use of intradiscal therapies.