Do Physical Symptoms Predict the Outcome of Surgical Fusion in Patients with Discogenic Low Back Pain?

다국어 초록 (Multilingual Abstract)

Study Design: Retrospective case series.
Purpose: To determine whether symptoms predict surgical outcomes for patients with discogenic low back pain (DLBP).
Overview of Literature: Specific diagnosis of DLBP remains difficult. Worsening of pain on flexion is a reported symptom of DLBP.
This study sought to determine whether symptoms predict surgical outcomes for patients with DLBP.
Methods: We investigated 127 patients with low back pain (LBP) and no dominant radicular pain. Magnetic resonance imaging was used to select patients with disc degeneration at only one level. If pain was provoked during discography, we performed fusion surgery (87 patients). Visual analogue scale score and responses to a questionnaire regarding symptoms including worsening of pain on flexion or extension were assessed. Symptom sites before surgery were categorized into LBP alone, or LBP plus referred inguinal or leg pain. We followed 77 patients (average 3.0 years) and compared symptoms before surgery with surgical outcome.
Results: Sixty-three patients with a good outcome showed postsurgical pain relief (≥60% pain relief) and 14 patients with a poor outcome did not (<60% pain relief). In patients with good outcomes, worsening of LBP was evident in 65% of cases on flexion and in 35% on extension. However, these findings were not significantly different from those in patients with poor outcomes. The percentage of patients with LBP alone was significantly lower and the percentage of patients with LBP plus referred inguinal or leg pain was significantly higher in the group with good surgical outcome compared with patients in the group with poor surgical outcome (p <0.05).
Conclusions: Worsening of pain on extension may be a symptom of DLBP. Surgical outcomes were superior in patients with both LBP and either referred inguinal or leg pain compared with those having LBP alone.

참고문헌 (Reference)

1 Nachemson AL, "The lumbar spine an orthopaedic challenge" 1 : 59-71, 1976

2 Nakamura SI, "The afferent pathways of discogenic lowback pain: evaluation of L2 spinal nerve infiltration" 78 : 606-612, 1996

3 Buenaventura RM, "Systematic review of discography as a diagnostic test for spinal pain: an update" 10 : 147-164, 2007

4 Ohtori S, "Sensory innervation of the dorsal portion of the lumbar intervertebral discs in rats" 26 : 946-950, 2001

5 Hellum C, "Predictors of outcome after surgery with disc prosthesis and rehabilitation in patients with chronic low back pain and degenerative disc: 2-year follow-up" 21 : 681-690, 2012

6 Esposito P, "Predictive value of MRI vertebral end-plate signal changes (Modic) on outcome of surgically treated degenerative disc disease: results of a cohort study including 60 patients" 52 : 315-322, 2006

7 Ohtori S, "Pathomechanisms of discogenic low back pain in humans and animal models" 15 : 1347-1355, 2015

8 Havakeshian S, "Negative beliefs and psychological disturbance in spine surgery patients: a cause or consequence of a poor treatment outcome?" 22 : 2827-2835, 2013

9 Pfirrmann CW, "Magnetic resonance classification of lumbar intervertebral disc degeneration" 26 : 1873-1878, 2001

10 Oikawa Y, "Lumbar disc degeneration induces persistent groin pain" 37 : 114-118, 2012

11 Lotz JC, "Innervation, inflammation, and hypermobility may characterize pathologic disc degeneration: review of animal model data" 88 (88): 76-82, 2006

12 Zamani AA, "Functional MRI of the lumbar spine in erect position in a superconducting open-configuration MR system: preliminary results" 8 : 1329-1333, 1998

13 Ohtori S, "Effectiveness of L2 spinal nerve infiltration for selective discogenic low back pain patients" 15 : 731-736, 2010

14 Modic MT, "Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging" 166 : 193-199, 1988

15 Donelson R, "Centralization phenomenon: its usefulness in evaluating and treating referred pain" 15 : 211-213, 1990

16 Laslett M, "Centralization as a predictor of provocation discography results in chronic low back pain, and the influence of disability and distress on diagnostic power" 5 : 370-380, 2005

17 Macnab I, "Backache" Williams & Wilkins 91-96, 1977

18 den Boer JJ, "A systematic review of bio-psychosocial risk factors for an unfavourable outcome after lumbar disc surgery" 15 : 527-536, 2006

19 Carragee EJ, "A gold standard evaluation of the “discogenic pain” diagnosis as determined by provocative discography" 31 : 2115-2123, 2006