Article Text

Download PDFPDF

LB0001 Intradiscal glucocorticoid injection for patients with chronic low back pain associated with active discopathy: a randomized trial
  1. C Nguyen1,
  2. I Boutron1,
  3. G Baron1,
  4. K Sanchez2,
  5. C Palazzo1,
  6. R Benchimol2,
  7. G Paris1,
  8. E James-Belin2,
  9. M-M Lefèvre-Colau1,
  10. J Beaudreuil3,
  11. J-D Laredo3,
  12. A Béra-Louville4,
  13. A Cotten4,
  14. J-L Drapé1,
  15. A Feydy1,
  16. P Ravaud1,
  17. F Rannou1,
  18. S Poiraudeau1
  1. 1Université Paris Descartes
  2. 2Assistance Publique - Hôpitaux de Paris
  3. 3Université Paris Diderot, Paris
  4. 4Université Lille 2, Lille, France


Background Active discopathy is associated with a specific phenotype of chronic low back pain (cLBP). Local inflammation has a role in active discopathy-associated symptoms (1).

Objectives To assess the efficacy of a single glucocorticoid intradiscal injection (GC IDI) in cLBP patients with active discopathy.

Methods We conducted a prospective, parallel-group, double-blind, randomized controlled study in 3 tertiary care centers in France. 135 cLBP patients with active discopathy on MRI were enrolled. They received a single GC IDI (25 mg prednisolone acetate) during discography (n=67) or discography alone (n=68). The primary outcome was the percentage of patients with LBP intensity in the previous 48 hr <40 on an 11-point numeric rating scale (NRS, 0 no pain - 100 maximal pain) at 1 month. The main secondary outcomes were LBP intensity and persisting active discopathy on MRI at 12 months post-intervention, and spine-specific limitations in activities, health-related quality of life, anxiety and depression, employment status and analgesics and non-steroidal anti-inflammatory drugs consumption at 1 and 12 months.

Results All randomized patients were included in the primary efficacy analysis. At 1 month, the percentage of responders (LBP intensity <40) was higher in the GC IDI than control group (36/65 [55.4%] vs 21/63 [33.3%]; absolute risk difference [95% confidence interval] 22.1 [5.5;38.7]); p=0.009. In the sensitivity analysis, mean reduction [95% CI] in LBP intensity from baseline to 1 month was greater in the GC IDI group compared to the control group (-32.5 [-38.2;-26.8] vs -17.5 [-23.3;-11.7], respectively; absolute difference [95% CI] -15.0 [-22.9;-7.1], p<0.001).

At 1 month, the percentage of patients reporting an improvement in spine-specific limitations in activities was higher in the GC IDI than control group (55/65 [84.6%] vs 34/63 [54.0%]; absolute risk difference [95% CI] 30.5 [15.7; 45.2], p<0.001). The 2 groups did not differ in LBP intensity at 12 months and in most of the secondary outcomes at 1 and 12 months. 102/119 (85.7%) patients would agree to a second intervention. We found no cases of rapidly destructive disc disease or intervertebral disc calcifications.

Conclusions In active discopathy-associated cLBP, a single GC IDI reduces LBP at 1 month post-intervention but not at 12 months.

Registration number NCT00804531 (First received: December 8, 2008. Last updated: June 23, 2016).


  1. Nguyen C, Poiraudeau S, Rannou F. From Modic 1 vertebral-endplate subchondral bone signal changes detected by MRI to the concept of 'active discopathy'. Ann Rheum Dis. 2015 Aug;74(8):1488–94.


Acknowledgements The study was funded by a research grant from the French Ministry of Health (Programme Hospitalier de Recherche Clinique, project no. P070157). The authors thank URC-CIC Paris Descartes Necker/Cochin (Christelle Auger and Nellie Moulopo) for implementation, monitoring and data management of the study.

Disclosure of Interest None declared

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.