Curr Rev Musculoskelet Med (2008) 1:103–107 changes. Intradiscal steroid injections at the time of discog- raphy led to signiﬁcant improvement in patients with inﬂammatory end-plate changes in all outcome scales but only minimal temporary improvement in patients without end-plate changes. Buttermann concluded that spinal steroid injections are more effective in patients with MRI ﬁndings of inﬂammation, speciﬁcally adjacent end-plate changes. Conclusion Based on the current literature, it is unlikely that intradiscal steroids offer much clinical improvement in pain or function for patients with discogenic low back pain. While earlier studies done without control groups have shown encouraging results, more recent controlled trials reveal minimal if any beneﬁt. Recent literature suggests that patients with Modic changes on MRI and signs of end-plate inﬂammatory chan- ges may beneﬁt the most from intradiscal steroid injections. Research analyzing this subgroup may deﬁnitvely determine whether there is a role in this subpopulation. Current litera- ture does not support routine clinical use of intradiscal steroids for the treatment of discogenic low back pain. References 1. Woodwell D. National Ambulatory Medical Care Survey: 1996 Summary. Advance Data #295 1997. 2. Frymoyer JW. Lumbar disk disease: epidemiology. Instr Course Lect 1992;41:217–23. 3. Bogduk N. The lumbar disc and low back pain. Neurosurg Clin N Am 1991;2:791–806. 4. Crock HV. Internal disc disruption. A challenge to disc prolapse 50 years on. Spine 1986;11:650–3. 5. Crock HV. A reappraisal of intervertebral disc lesions. Med J 1970;1:983–9. 6. Merskey H, Bogduk N. Classiﬁcation of chronic pain: descrip- tions of chronic pain syndromes and deﬁnitions of pain terms. Seattle: IASP Press;1994. p. 180–1. 7. Khot A, Bowditch M, Powell J, Sharp D. The use of intradiscal steroid therapy for lumbar discogenic pain: a randomized con- trolled trial. Spine 2004;29:833–6. 8. Zhou Y, Abdi S. Diagnosis and minimally invasive treatment of lumbar discogenic pain. A review of the literature. Clin J Pain 2006;22:468–81. 107 9. Feffer HL. Therpeutic intradiscal hydrocortisone: a long-term study. Clin Orthop Relat Res 1969;67:100–4. 10. White AA, Gordon SL. Synopsis: workshop on idiopathic low- back pain. Spine 1982;7:141–9. 11. Green LN. Dexamethasone in the management of symptoms due to herniated lumbar disc. J Neurol Neurosurg Psychiatry 1975;38: 1211–7. 12. McCarron RF, Wimpee MW, Hudkins PG, et al. The inﬂamma- tory effect of the nucleus pulposus. A possible element in the pathogenesis of low back pain. Spine 1987;12:760–4. 13. Yong-Hing K, Kirkaldy-Willis WH. The pathophysiology of degenerative disease of the lumbar spine. Orthop Clin North Am 1983;14:501–3. 14. Kirkaldy-Willis WH, Farfan HF. Instability of the lumbar spine. Clin Orthop Relat Res 1982;165:110–23. 15. Brinckmann P, Horst M. The inﬂuence of vertebral body fracture, intradiscal injection, and partial discectomy on the radial bulge and height of human lumbar discs. Spine 1985;10(2):138–45. 16. Kato F, Mimatsu K, Kawakami N, et al. Changes in intervertebral disc after discography with intradiscal injection of corticosteroids observed with MRI. J Neurol Orthop Med Surg 1993;14:210–6. 17. Aoki M, Kato F, Mimatsu K, Iwata H. Histologic changes in the intervertebral disc after intradiscal injections of methylpredniso- lone acetate in rabbits. Spine 1997;22(2):127–31. 18. Ito S, Usui H, Maruyama K, Muro T. Roentgenographic evalu- ation of ossiﬁcation and calciﬁcation of the lumbar spinal canal after intradiscal betamethasone injection. J Spinal Disord 2001; 14(5):434–8. 19. Menei P, Fournier D, Alhayek G, Mercier P, Francois H, Audran M, Guy G. Rev Rhum Mal Osteoartic 1991;58(9):605–9. 20. Wilkinson HA, Schuman N. Intradiscal corticosteroids in the treatment of lumbar and cervical disc problems. Spine 1980;5: 385–9. 21. Leao L. Intradiscal injection of hydrocortisone and prednisolone in the treatment of low back pain. Rheumatism 1960;16:72–7. 22. Graham CE. Chemonucleolysis: a preliminary report on a double blind study comparing chemonucleolysis and intradiscal admin- istration of hydrocortisone in the treatment of backache and sciatica. Ortho Clin North Am 1975;6:259–63. 23. Simmons JW, McMillin JN, Emery SF, et al. Intradiscal steroids. A prospective double blind clinical trial. Spine 1992;17:S172–75. 24. Modic MT, Steinberg PM, Ross JS, Masaryk TJ, Carter JR. Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology 1988;166:193–9. 25. Mayahi R, Khot A, Sharp DJ, Powell J. Can modic changes on MRI predict clinical response to steroids in discogenic low back pain? J Bone Joint Surg (Br) 2005;87-B (Supp 3):233. 26. Bull TM, Sharp DJ, Powell JM. The efﬁcacy of intra-discal ste- roid injection compared to modic changes in degenerate lumbar discs. J Bone Joint Surg (Br) 1998;80-B(1S):47. 27. Buttermann GR. The effect of spinal steroid injections for degenerative disc disease. The Spine J 2004;4:495–505.