Lumbosacral immobilization following glucocorticoid intradiscal injection in patients with chronic low back pain and active discopathy: A feasibility study

Article type: Research Article

Authors: Couzi, Emmanuel^{a; b} | Boisson, Margaux^b | Segretin, François^b | Lefèvre-Colau, Marie-Martine^{a; b; c; d} | Roren, Alexandra^{a; b; c; d} | Moreau, Sylvain^b | Goret, Stéphanie^b | Poiraudeau, Serge^{a; b; c; d; 1} | Rannou, François^{a; d; e} | Nguyen, Christelle^{a; d; e; *}

Affiliations: [a] Université Paris Descartes, Faculté de Médecine, Sorbonne Paris Cité, Paris, France | [b] AP-HP, Hôpitaux Universitaires Paris Centre-Groupe Hospitalier Cochin, Service de Rééducation et de Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, Paris, France | [c] INSERM UMR 1153, Centre de Recherche Épidémiologie et Statistique, Sorbonne Paris Cité, ECaMO Team, Paris, France | [d] Institut Fédératif de Recherche sur le Handicap, Paris, France | [e] INSERM UMR 1124, Laboratoire de Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire, Faculté des Sciences Fondamentales et Biomédicales, Paris, France

Correspondence: [*] Corresponding author: Christelle Nguyen, %****␣bmr-33-bmr191552_temp.tex␣Line␣125␣**** Assistance Publique – Hôpitaux de Paris, Rééducation et Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, Hôpitaux Universitaires Paris Centre – Groupe Hospitalier Cochin 27, Rue du Faubourg Saint-Jacques, 75014 Paris, France. Tel.: +33 1 58 41 29 45; Fax: +33 1 58 41 25 38; E-mail: christelle.nguyen2@aphp.fr.

Note: [1] Deceased.

Abstract: BACKGROUND: In people with chronic low back pain (cLBP) and active discopathy, glucocorticoid intradiscal injection (GC IDI) reduces LBP in the short-term. Lumbosacral immobilization may be useful to obtain long-term results. OBJECTIVE: To assess the feasibility of a lumbosacral immobilization using a pantaloon cast following GC IDI in people with cLBP sand active discopathy. METHODS: We conducted a retrospective feasibility study. Participants were allocated to experimental or control groups by preferences. The experimental group received lumbosacral immobilization using a custom-made pantaloon cast worn continuously for one week following a GC IDI of 25 mg of prednisolone acetate. The control group received GC IDI alone. The primary endpoint was the feasibility of lumbosacral immobilization assessed by the rate of refusal and early withdrawal of the cast. RESULTS: Twelve patients were offered lumbosacral immobilization following GC IDI: the rate of refusal was 3/12 (25.0%) and was 3/9 (33.3%) of early withdrawal. Mean (95% CI) acceptability of the procedure was 55.0 (26.9–83.1)/100 in the experimental group (N= 6) and 61.6 (25.1–98.2)/100 in the control group (N= 6). CONCLUSIONS: We found high rates of refusal and early withdrawal of the lumbosacral immobilization using a pantaloon cast following GC IDI in people with nonspecific cLBP and active discopathy.

Keywords: Chronic low back pain, Modic 1, active discopathy, intradiscal therapy, glucocorticoid, lumbar brace

DOI: 10.3233/BMR-191552

Journal: Journal of Back and Musculoskeletal Rehabilitation, vol. 33, no. 6, pp. 931-937, 2020