Comparison of intradiscal restorative injections and intradiscal electrothermal treatment (IDET) in the treatment of low back pain.

This was a pilot study to test the potential effectiveness of intradiscal restorative injection therapy and compare with intradiscal electrothermal therapy (IDET). Thirty-five patients for intradiscal injection and seventy-four for IDET took part in the study. All patients had intractable chronic discogenic low back pain, confirmed by discogram study. Injection solution consisted of glucosamine and chondroitin sulfate combined with hypertonic dextrose and dimethylsulfoxide. Outcome was rated as 0-10 on visual analog scale (VAS), satisfaction rate, and flare up before and after the procedures. Post-procedure, patients were followed from 6 months to 18 months. Pain relief was statistically significant for both procedures, but slightly better for injections (2.2 VAS) than for IDET (1.27 VAS). 47.8% of IDET patients reported that they felt better, whereas 65.6% of injection patients reported this outcome. Among IDET patients, 35.8% reported they were worse, while no restorative injection patient reported worsening of pain. Post-procedure flare-up occurred more frequently after restorative injection (81%) than after IDET (68.9%) and was more severe (7.9 versus 6.1 VAS, respectively). However, the duration of pain flare-up was notably shorter for restorative injections (8.6 days) than for IDET (33.1 days). Biochemical intradiscal restorative injections may be useful to reduce pain and disability in patients with chronic discogenic low back pain, and have clinically similar efficacy to IDET, but with improved cost-benefit ratio. The results of this study indicate that controlled random prospective comparative studies need to be performed to establish the efficacy of this treatment.