Skip to main content
SpringerLink
Log in

Intradiscal glycerol of bupivacaine in the treatment of low back pain

  • Clinical Articles
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Summary

A total of 15 patients suffering from chronic low back pain were treated with an intradiscal injection of either 1 ml of 50% glycerol or 2 ml of 0.5% bupivacaine. Most (60%) of the patients had previously undergone spinal surgery for lumbar disc herniation or spinal stenosis and 73% showed clinical signs and symptoms of segmental instability of the lumbar spine. According to self-evaluation questionnaires, immediate response to both treatments was mainly good. Of the 9 patients who received glycerol, 56% showed subjective improvement on the first day after the injection and after two weeks, 45% of the patients still felt improvement. After one month, however, the pain had reappeared in all except one (11%) patient. The corresponding numbers for the 6 with bupivacaine treated patients were 83%, 67%, and 17%. Based on the very short duration of response to the treatment, we did not find intradiscal injections with these agents to be cost-effective. In our department, this therapeutic approach is no longer employed in patients with chronic discogenic pain.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bogduk N, Tynan W, Wilson AS (1981) The nerve supply to human lumbar intervertebral disc. J Anat 132: 39–56

    PubMed  CAS  Google Scholar 

  2. Cappabianca P, Spaziante R, Graziussi G, Taglialatela G, Peca C, De-Divitiis E (1995) Percutaneous retrogasserian glycerol rhizolysis for treatment of trigeminal neuralgia. Technique and results in 191 patients. J Neurosurg Sci 39: 37–45

    PubMed  CAS  Google Scholar 

  3. Crock HV (1986) Internal disc disruption. A challenge to disc prolapse fifty years on. Spine 11: 650–653

    Article  PubMed  CAS  Google Scholar 

  4. El-Khoury GY, Renfrew DL (1991) Percutaneous procedures for the diagnosis and treatment of lower back pain: Discography, facet-joint injection, and epidural injection. AJR 157: 685–691

    PubMed  CAS  Google Scholar 

  5. Fairbank JCT, Couper J, Davies JB, O’Brien JP (1980) The Oswestry low back pain disability questionnaire. Physiotherapy 66: 271–273

    PubMed  CAS  Google Scholar 

  6. Graham CE (1975) Chemonucleolysis: a preliminary report on double-blind study comparing chemonucleolysis and intradiscal administration of hydrocortisone in the treatment of back-ache and sciatica. Orthop Clin North Am 6: 259–263

    PubMed  CAS  Google Scholar 

  7. Håkanson S (1981) Trigeminal neuralgia treated by the injection of glycerol into the trigeminal cistern. Neurosurgery 9: 638–646

    Article  PubMed  Google Scholar 

  8. Jackson HC, Winklemann RK, Bickel WH (1966) Nerve endings in the human lumbar spine and related structures. J Bone Joint Surg 48A: 1272–1281

    Google Scholar 

  9. Kotilainen E, Valtonen S (1993) Clinical instability of the lumbar spine after microdiscectomy. Acta Neurochir (Wien) 125: 120–126

    Article  CAS  Google Scholar 

  10. Kotilainen E, Valtonen S (1994) Percutaneous nucleotomy in the treatment of lumbar disc herniation; results after a mean follow-up of 2 years. Acta Neurochir (Wien) 128: 47–52

    Article  CAS  Google Scholar 

  11. Kuslich SD, Ulstrom CL, Michael CJ (1991) The tissue origin of low back pain and sciatica: a report of pain response to tissue stimulation during operations on the lumbar spine using local anesthesia. Orthop Clin North Am 22: 181–187

    PubMed  CAS  Google Scholar 

  12. Malisnky J (1959) The ontogenetic development of nerve terminals in the intervertebral disc of man. Acta Anat (Basel) 38: 96–113

    Google Scholar 

  13. Marshall LL, Trethewie ER, Curtain CC (1977) Chemical radiculitis. A clinical, physiological and immunological study. Clin Orthop 129: 61–67

    PubMed  Google Scholar 

  14. McCarron RF, Wimpee MW, Hudkins PG, Laros GS (1987) The inflammatory effect of nucleus pulposus. A possible element in the pathogenesis of low-back pain. Spine 12: 760–764

    Article  PubMed  CAS  Google Scholar 

  15. Mendel T, Wink CS, Zimny ML (1990) Neural elements in human cervical intervertebral discs. Spine 17: 132–135

    Article  Google Scholar 

  16. Nakamura S, Takahashi K, Takahashi Y, Morinaga T, Shimada Y, Moriya H (1996) Origin of nerves supplying the posterior portion of lumbar intervertebral discs in rats. Spine 21: 917–924

    Article  PubMed  CAS  Google Scholar 

  17. Simmons JW, McMillin JN, Emery SF, Kimmich SJ (1992) Intradiscal steroids. A prospective double-blind clinical trial. Spine 17 [Suppl]:172–175

    Article  Google Scholar 

  18. Vanharanta H, Sachs BL, Spivey M, Hochschuler SH, Guyer RD, Rashbaum RF, Ohnmeiss DD, Mooney V (1988) A comparison of CT/discography, pain response and radiographic disc height. Spine 13: 321–324

    Article  PubMed  CAS  Google Scholar 

  19. Vanharanta H, Sachs BL, Spivey MA, Guyer MA, Hochschuler SH, Rashbaum RF, Johnson RG, Ohnmeiss D, Mooney V (1987) The relationship of pain provocation to lumbar disc deterioration as seen by CT/discography. Spine 12: 295–298

    Article  PubMed  CAS  Google Scholar 

  20. Wilkinson HA, Schuman N (1980) Intradiscal corticosteroids in the treatment of lumbar and cervical disc problems. Spine 5: 385–389

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Turku University Central Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland

    E. Kotilainen

  2. Department of Surgery, Turku University Central Hospital, Turku, Finland

    E. Kotilainen

  3. Department of Anaesthesiology, Turku University Central Hospital, Turku, Finland

    P. Muittari & O. Kirvelä

Authors
  1. E. Kotilainen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Muittari
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. O. Kirvelä
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kotilainen, E., Muittari, P. & Kirvelä, O. Intradiscal glycerol of bupivacaine in the treatment of low back pain. Acta Neurochir 139, 541–545 (1997). https://doi.org/10.1007/BF02750997

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02750997

Keywords

Search

Navigation