Objective Determine the effectiveness of intradiscal corticosteroid injection (IDCI) for the treatment of discovertebral low back pain. Design Systematic review. Population Adults with chronic low back pain (CLBP) attributed to disc or vertebral endplate pain as evidenced by positive provocation discography or Modic 1 or 2 changes on MRI. Intervention Fluoroscopically or CT-guided IDCI. Comparison Sham/placebo procedure including intradiscal saline, anesthetic, discography alone, or other active treatment. Outcomes Reduction in CLBP reported on Visual Analog Scale (VAS) or Numeric Rating Scale (NRS) and reduction in disability reported by validated scale such as Oswestry Disability Index (ODI). Methods Four reviewers independently assessed publications before January 31, 2023 in Medline, Embase, CENTRAL, and CINAHL. The quality of evidence was evaluated using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) framework. The risk of bias in randomized trials was evaluated using the Cochrane Risk of Bias tool (V2). Results Of the 7806 unique records screened, six randomized controlled trials (RCTs) featuring 603 total participants ultimately met inclusion. In multiple RCTs, IDCI was found to reduce pain and disability between one and six months in those with Modic 1 and 2 changes but not in those selected by provocation discography. Conclusion According to GRADE, there is low-quality evidence that IDCI reduces pain and disability in individuals with chronic discovertebral LBP as evidenced by Modic 1 and 2 changes for up to six months, but not in those selected by provocation discography.

中文翻译：

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椎间盘内注射皮质类固醇治疗慢性椎间盘腰痛的有效性：系统评价

目的 确定椎间盘内注射皮质类固醇（IDCI）治疗椎间盘性腰痛的有效性。设计系统审查。人群 因椎间盘或椎体终板疼痛而患有慢性腰痛 (CLBP) 的成年人，如阳性激发椎间盘造影或 MRI 上 Modic 1 或 2 级变化所证明。透视或 CT 引导 IDCI 干预。比较假手术/安慰剂手术，包括椎间盘内盐水、麻醉、单独椎间盘造影或其他积极治疗。结果 根据视觉模拟量表 (VAS) 或数字评定量表 (NRS) 报告 CLBP 减少，并根据 Oswestry 残疾指数 (ODI) 等经过验证的量表报告残疾减少。方法 四位评审员独立评估了 2023 年 1 月 31 日之前在 Medline、Embase、CENTRAL 和 CINAHL 上发表的出版物。使用推荐、评估、开发和评估等级 (GRADE) 框架评估证据的质量。使用 Cochrane 偏倚风险工具 (V2) 评估随机试验中的偏倚风险。结果 在筛选的 7806 份独特记录中，有 6 项随机对照试验 (RCT) 最终纳入了 603 名参与者。在多项随机对照试验中，发现 IDCI 可以减轻 Modic 1 和 2 改变患者 1 至 6 个月内的疼痛和残疾，但对于通过激发椎间盘造影选择的患者则不然。结论 根据 GRADE，低质量证据表明 IDCI 可以减轻慢性发现椎体腰痛患者的疼痛和残疾，Modic 1 和 2 变化长达六个月即可证明，但对于通过激发椎间盘造影选择的患者则不然。