Intradiscal Procedures for Discogenic Low Back Pain: Considerations and Implications - A Narrative Review

Discogenic low back pain (DLBP) is a prevalent contributor to chronic low back pain, often resulting from intervertebral disc degeneration associated with inflammation. Various intradiscal therapeutic procedures have been developed to address DLBP, including intradiscal steroid injections, methylene blue injections, platelet-rich plasma (PRP) injections, intradiscal electrothermal therapy (IDET), and both continuous (CRF) and pulsed (PRF) radiofrequency techniques. Intradiscal therapeutic procedures refer to minimally invasive interventions targeting the intervertebral disc, typically performed through percutaneous access under fluoroscopic or computed tomography guidance. These procedures aim to modulate nociceptive signaling or reduce intradiscal inflammation to relieve pain. This review aims to evaluate the existing evidence regarding the efficacy of intradiscal procedures for DLBP while assessing their potential risks, particularly concerning the acceleration of disc degeneration. Although certain interventions, specifically PRP and PRF, have yielded promising results in alleviating DLBP, the overall number of studies reporting positive therapeutic outcomes remains insufficient, and most lack long-term follow-up data. Significant concerns also arise regarding the potential for disc degeneration owing to needle insertion associated with intradiscal therapeutic procedures. Furthermore, IDET and CRF techniques can result in thermal injury to the disc. Evidence from discography studies suggests that disc degeneration may be accelerated, especially when larger needles are employed during the procedure. In addition, repeated interventions may lead to further intradiscal injury and accelerate disc degeneration. Despite these concerns, we propose that performing the procedure once or twice using a thin needle may be justifiable for patients with severe DLBP. Taken together, current evidence suggests that while selected intradiscal procedure, such as PRP and PRF, may provide transient benefit, heterogeneity in study design, short follow-up durations, and procedural risks limit definitive recommendations for routine clinical use. Future high-quality, long-term studies are crucial to enhance our understanding of the therapeutic benefits and associated risks of these interventions.