Lidocaine cytotoxicity to the zygapophysial joints in rabbits: changes in cell viability and proteoglycan metabolism in vitro

Spine (Phila Pa 1976). 2009 Dec 15;34(26):E945-51. doi: 10.1097/BRS.0b013e3181b8adf2.


STUDY DESIGN.: To examine whether lidocaine cytotoxicity to chondrocytes has been implicated in the development of osteoarthritis of the zygapophysial joints. OBJECTIVE.: This study was performed to determine the effects of varying concentrations and exposure times of lidocaine on the viability and proteoglycan metabolism of rabbit zygapophysial chondrocytes in vitro. SUMMARY OF BACKGROUND DATA.: Zygapophysial joint injections are commonly administered with lidocaine for chronic spinal pain in orthopedic treatment. A lot of studies on the effect of zygapophysial joint injections are clinical, but many questions on the effect of lidocaine to zygapophysial chondrocytes remain unanswered. METHODS.: Cartilage was obtained from zygapophysial joints of adult rabbits. Chondrocytes in alginate beads were cultured in medium containing 6% fetal calf serum at 370 mOsmol at cell densities of 4 million cells/mL. They were then cultured for 24 hours under 21% oxygen with 0.125%, 0.25%, 0.5%, and 1% lidocaine, and without lidocaine as control. The cell viability profile across intact beads was determined by manual counting using fluorescent probes (LIVE/DEAD assay) and transmission electron microscopy. Lactate production was measured enzymatically as a marker of energy metabolism. Glycosaminoglycan (GAG) accumulation was measured using a modified dimethylmethylene blue assay. RESULTS.: Cell viability decreased in a time- and dose-dependent manner in the concentration range of 0.125% to 1.0% lidocaine under the confocal microscope. Under the electron microscope, apoptosis increased as the concentration of lidocaine increased. GAG accumulation/tissue volume decreases as the concentration of lidocaine increased. However, GAG produced per million cells and the rate of lactate production per live cell was significantly higher for cells cultured at 0.5% and 1% lidocaine than the control group. CONCLUSION.: While these in vitro results cannot be directly extrapolated to the clinical setting, this data suggestcaution in prolonged exposure of zygapophysial cartilage to high concentration lidocaine.

MeSH terms

  • Analysis of Variance
  • Animals
  • Cartilage, Articular / drug effects
  • Cartilage, Articular / metabolism
  • Cell Count
  • Cell Survival / drug effects
  • Cells, Cultured
  • Chondrocytes / drug effects*
  • Chondrocytes / metabolism
  • Chondrocytes / pathology
  • Dose-Response Relationship, Drug
  • Glycosaminoglycans / metabolism
  • Lactic Acid / biosynthesis
  • Lidocaine / toxicity*
  • Microscopy, Confocal
  • Microscopy, Electron, Transmission
  • Osteoarthritis / chemically induced
  • Osteoarthritis / metabolism
  • Osteoarthritis / pathology
  • Proteoglycans / metabolism*
  • Rabbits
  • Time Factors
  • Zygapophyseal Joint / drug effects*
  • Zygapophyseal Joint / metabolism
  • Zygapophyseal Joint / pathology


  • Glycosaminoglycans
  • Proteoglycans
  • Lactic Acid
  • Lidocaine