Open AccessIs the History of a Surgical Discectomy Related to the Source of Chronic Low Back Pain?
Author(s) -
Michael J. DePalma,
Jessica M. Ketchum,
Thomas R. Saullo,
Ben L. Laplante
Publication year - 2012
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2012/15/e53
Subject(s) - medicine , facet joint , discectomy , low back pain , discography , provocation test , sacroiliac joint , chronic pain , surgery , lumbar , back pain , medical history , physical therapy , pathology , alternative medicine
Background: Recurrent or persistent low back pain (LBP) after surgical discectomy (SD)for intervertebral disc herniation has been well documented. The source of low back painin these patients has not been examined.Objective: To compare the distribution of the source of chronic LBP between patients withand without a history of SD.Study Design: Retrospective chart review.Setting: Academic spine center.Patients: Charts from 358 consecutive patients were reviewed. Charts noting the absence/presence of SD in patients who subsequently underwent diagnostic injections to determinethe source of chronic LBP were included resulting in 158 unique cases for analysis.Methods: Patients underwent either dual diagnostic facet joint blocks, intra-articulardiagnostic sacroiliac joint injections, provocation lumbar discography, or anesthetic injectioninto putatively painful interspinous ligaments/opposing spinous processes/posterior fusionhardware. If the initial diagnostic procedure was negative, the next most likely structurein the diagnostic algorithm was interrogated. Subsequent diagnostic procedures were notperformed after the source of chronic LBP was identified.Outcome: The source of chronic LBP was diagnosed as discogenic pain (DP), facet jointpain (FJP), sacroiliac joint pain (SIJP), or other sources of chronic LBP.Results: Based on a Fisher’s exact test, there was marginal evidence the distribution of thesource of chronic LBP differed for those with and without a history of SD (P = 0.080). Posthoc comparisons suggested that patients with a history of SD have a higher probability ofDP compared to those without a history of SD (82% versus 41%; P = 0.011). Differencesin the probability of FJP, SIJP, or other sources between the SD history groups were notsignificant.Limitations: Small sample size, restrospective design, and possible false-positive results.Conclusions: This is the first published investigation of the tissue source of chronic LBPafter SD. It appears that DP is the most common reason for chronic LBP after SD. If morerigorous study confirms our findings, future biologic treatments may hold value in repairingsymptomatic annular fissures after SD.Key words: surgical discectomy, chornic low back pain, discogenic pain, facet joint,sacroiliac joint, low back pain, diagnostic injections, medial branch block, lumbar provcationdiscography