Département de médecine physique et de réadaptation, CHU Lapeyronie, Univ Montpellier, Montpellier, France.
Département de rhumatologie, CHU Lapeyronie, Univ Montpellier, Montpellier, France.
Ann Phys Rehabil Med. 2021 Mar;64(2):101396. doi: 10.1016/j.rehab.2020.05.003. Epub 2020 Aug 27.
The benefit of an intradiscal injection of corticosteroids for low back pain with active discopathy is not totally resolved.
The objective of this study was to estimate the clinical efficacy of an intradiscal injection of glucocorticoids versus lidocaine in patients with low back pain and active discopathy (Modic 1 changes).
A prospective, single-blind, randomized controlled study was conducted in 2 tertiary care centers with spine units. We enrolled 50 patients (mean age 50 years; 46% women) with lumbar active discopathy on MRI and failure of medical treatment for more than 6 weeks. Participants were randomly assigned to receive an intradiscal injection of glucocorticoids [50mg prednisolone acetate (GC group), n=24] or lidocaine [40mg (L group), n=26] by senior radiologists. Outcome measures were low back pain in the previous 8 days (10-point visual analog scale), Dallas Pain Questionnaire, Oswestry Disability Index, analgesic treatment and work status at 1, 3 and 6 months as well as pain at 1, 2 and 3 weeks. The primary outcome was change in pain between baseline and 1 month.
Data for 39 patients (78%; 17 in the GC group, 22 in the L group) were analyzed for the primary outcome. Pain intensity was significantly reduced at 1 month in the GC versus L group [mean (SD) -2.7 (2.3) and +0.1 (2.0), P<0.001] but not at 3 and 6 months. At 1 and 3 months, the groups significantly differed in daily activities of the Dallas Pain Questionnaire in favour of the GC group. The groups did not differ in consumption of analgesics or professional condition at any time. No serious intervention-related adverse events occurred. Study limitations included patients lost to the study because of injection-related technical issues in the L5/S1 disc and short time of follow-up.
As compared with intradiscal injection of lidocaine, intradiscal injection of prednisolone acetate for low back pain with active discopathy may reduce pain intensity at 1 month but not at 3 and 6 months.
对于伴有活动性椎间盘病的腰痛患者，椎间盘内注射皮质类固醇的益处尚未完全明确。
本研究旨在评估椎间盘内注射糖皮质激素与利多卡因治疗伴有活动性椎间盘病（Modic 1 改变）的腰痛患者的临床疗效。
在 2 个设有脊柱专科的三级医疗机构中开展了一项前瞻性、单盲、随机对照研究。我们纳入了 50 例 MRI 显示腰椎活动性椎间盘病且经 6 周以上药物治疗无效的患者（平均年龄 50 岁，46%为女性）。参与者被随机分配至接受椎间盘内注射糖皮质激素（50mg 醋酸泼尼松龙，GC 组，n=24）或利多卡因（40mg，L 组，n=26），由资深放射科医生进行操作。主要结局指标为治疗前 8 天的腰痛（10 分视觉模拟评分）、达拉斯疼痛问卷、Oswestry 残疾指数、镇痛治疗以及治疗后 1、3 和 6 个月的工作状态，以及治疗后 1、2 和 3 周的疼痛。主要结局为治疗后 1 个月时的疼痛变化。
在 39 例患者（78%，GC 组 17 例，L 组 22 例）中分析了主要结局。与 L 组相比，GC 组在治疗后 1 个月时疼痛强度显著降低（[均数（标准差）]-2.7（2.3）比+0.1（2.0），P<0.001），但在治疗后 3 个月和 6 个月时差异无统计学意义。在治疗后 1 个月和 3 个月时，两组患者的达拉斯疼痛问卷日常活动评分差异有统计学意义，GC 组的评分改善更明显。两组患者在任何时间点的镇痛药使用或职业状况均无差异。未发生与干预相关的严重不良事件。研究局限性包括因 L5/S1 椎间盘注射相关技术问题失访以及随访时间较短。
与椎间盘内注射利多卡因相比，对于伴有活动性椎间盘病的腰痛患者，椎间盘内注射醋酸泼尼松龙可能会在治疗后 1 个月时降低疼痛强度，但在治疗后 3 个月和 6 个月时无效。
