<p>The Technique of Intradiscal Injection: A Narrative Review</p>

Abstract

Background: Low back pain (LBP) is one of the most common spine diseases and represents the most frequent cause of absence from work in developed countries. Approximately 40% of chronic LBP is related to discogenic origin. The goal of the study is producing a review of literature to describe analytically the techniques of intradiscal injections. Methods: PubMed database was searched for clinical studies with the different key terms: "intradiscal", "injection", "steroid" "procedures", "techniques", "CT", "MRI", "fluoroscopy", "fluoroscopic", "guidance", "ozone", "ultrasound", "images". Only studies written in English, French, or Italian in which the intradiscal injection represents the main procedure for the low back discopathy treatment on humans were considered. We excluded the articles that do not mention this procedure; those which indicated that the intradiscal injection had happened accidentally during other treatments; those reporting the patient's pain was determined by other causes than the discopathy (facet joint syndrome, tumor, spondylodiscitis). Results: Thirty-one articles dated from 1969 to 2018 met the criteria. The examined population was 6843 subjects, 52.3% male and 47.7% female, with a mean age of 45.9 ±10.1 years. The techniques are highly variable in terms of procedure: different operators, needle guidance, injection sites, drugs, tilt angle of the needle). Conclusion: The efficacy and the safety of the intradiscal procedures are not easily comparable due to different types of studies and their limited number. Further studies are needed to standardize the intradiscal injection technique/procedure to improve safety, repeatability and effectiveness, and last but not least to reduce peri-and postoperative care and health-care costs.

Ultrasound‐guided L5/S1 intradiscal needle placement using biplanar approach with the patient in the lateral decubitus position: A report of three cases

“…Other measures to prevent the possible risks of discitis include double‐needle technique and preprocedure prophylactic antibiotics or even intradiscal placement of antibiotic 22,23 . The patients should be well informed that even with all the above‐mentioned measures, the risk of discitis still exists 8,18,20 . The following potential complications have been reported in the literature: nerve injury, temporary impaired sensitivity; vitreoretinal hemorrhages; thunderclap headache related to pneumoencephalus as a consequence of inadvertent intrathecal puncture; and 1 case of vertebrobasilar stroke.…”

The Role of Diagnostic Injections in Spinal Disorders: A Narrative Review

“…Finally, a narrative review by Migliore et al describes different intradiscal injection techniques, including guidance by fluoroscopy, CT, and CT plus fluoroscopy. Comparison of various efficacy and safety outcomes found that results were not easily comparable due to differences in highly variable procedural techniques, study designs, and a limited number of studies, thus, warranting more research on the efficacy and safety of these procedures [ 59 ].…”

Local Delivery of Senolytic Drug Inhibits Intervertebral Disc Degeneration and Restores Intervertebral Disc Structure

“…Such intervention has shown little progress in IVDD treatment over the past few decades, resulting in an increase in administration of therapeutic agents through direct intradiscal injection. [20][21][22] The intradiscal injection is a technique widely used in the LBP management of patients who are not responsive to rehabilitative and medical treatments. [20][21][22] Moreover, because repeated administrations of senolytic drugs for an extended period of time are generally required for effective removal of senescent cells in vivo, [6,[9][10][11] multiple intradiscal injections would be required.…”

“…[20][21][22] The intradiscal injection is a technique widely used in the LBP management of patients who are not responsive to rehabilitative and medical treatments. [20][21][22] Moreover, because repeated administrations of senolytic drugs for an extended period of time are generally required for effective removal of senescent cells in vivo, [6,[9][10][11] multiple intradiscal injections would be required. [16] However, multiple intradiscal injections to IVD may cause clinical disc problems such as discitis (infection of the discs) and potentially accelerate IVDD.…”