Curr Rev Musculoskelet Med (2008) 1:103–107 DOI 10.1007/s12178-007-9015-y The role of intradiscal steroids in the treatment of discogenic low back pain Stefan Muzin Æ Zacharia Isaac Æ Joseph Walker III Published online: 7 December 2007 Humana Press 2007 Abstract LBP is one of the most common reasons for visiting a doctor and is the most common cause of disability under age 45.Amongst a variety of etiologies, internal disc disruption (IDD) has been postulated as an important cause of low back pain. Treating discogenic low back pain con- tinues to be a challenge to physicians. Inﬂammation, either from direct chemical irritation or secondary to an autoim- mune response to the nucleus pulposus has been implicated as the primary pain source. Both steroids and non-steroidal anti-inﬂammatory drugs have partial effectiveness in treating pain associated with inﬂammation. Therefore, the rationale for using intradiscal steroids is to suppress the inﬂammation within the disc, thereby alleviating the patient’s symptoms. The goal of this article is to review the literature regarding the efﬁcacy of intradiscal steroids to treat low back pain of discogenic origin. Keywords Intradiscal steroids Methylprednisone Discogenic Disc disruption Modic Hydrocortisone Back pain Introduction Low back pain (LBP) remains a major public health concern in the US. LBP is one of the most common reasons for visiting a doctor and is the most common cause of S. Muzin (&) J. Walker III Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, USA e-mail: smuzin@gmail.com Z. Isaac Brigham and Women’s Ambulatory Spine Service, Harvard Medical School, Boston, USA disability under age 45 [1]. Approximately 60–80% of the US population will experience back pain at some point in their lives and 2–5% will have it at any given time [2]. According to recent estimates, the annual cost in the US is between 100 and 200 billion dollars. Amongst a variety of etiologies, internal disc disruption (IDD) has been postulated as an important cause of low back pain [3]. In 1970, Crock invented the term IDD as a condition marked by alteration in the internal structure and metabolic functions of the intervertebral disc, usually proceeded by injuries [4]. He described IDD in a group of patients with low back and leg pain who became worse after surgery for a suspected disc prolapse [5]. Annular tears (including radial and circumferential) are the major form of IDD. It is generally accepted that the diagnosis of discogenic pain due to IDD should meet the following criteria: (1) CT discography reveals an IDD; (2) pain should be reproduced on provocative injection of the contrast, and (3) as a con- trol, stimulation of at least 1 other disc fails to reproduce pain [6]. Discogenic back pain has been deﬁned clinically as chronic low back pain of a deep aching, nagging, or throbbing character, not completely relieved with rest, and sometimes with referred pain to one or both limbs [7]. Treating discogenic low back pain continues to be a chal- lenge to physicians. Over recent years, several minimally invasive treatment modalities such as intradiscal steroid injections, intradiscal electrothermal therapy (IDET), in- tradiscal radiofrequency (RF) thermocoagulation, and epidural steroid injections have been studied [8]. These methods have triggered a major interest among interventional pain physicians and provide new alternatives for patients with debilitating low back pain [9]. Although the major advantages of minimally invasive therapies