Intradiskal Treatments for Active Degenerative Disk Disease

Intradiskal steroid injections were first used 70 years ago. The initial failure of this treatment method can be ascribed to the absence of preclinical studies and of well-defined criteria for patient selection. Intradiskal calcifications were reported after triamcinolone hexacetonide or cortivazol injections, and proof of clinical benefits remained elusive. The concept of active degenerative disk disease (DDD) then emerged, and cases of incapacitating chronic low back pain with Modic I endplate changes were reported, leading to renewed interest in evaluating intradiskcal steroid injections. Prednisolone acetate was proven effective in providing short-term relief and was well tolerated in patients with incapacitating chronic low back pain and Modic I changes. This development highlights the importance of concomitant advances in identifying diagnostic entities and developing treatment strategies for patients with nonspecific low back pain.