Virginia iSpine Physicians, PC, Richmond, VA 23235, USA.
Pain Physician. 2012 Jan-Feb;15(1):E53-8.
Recurrent or persistent low back pain (LBP) after surgical discectomy (SD) for intervertebral disc herniation has been well documented. The source of low back pain in these patients has not been examined.
To compare the distribution of the source of chronic LBP between patients with and without a history of SD.
Retrospective chart review.
Academic spine center.
Charts from 358 consecutive patients were reviewed. Charts noting the absence/presence of SD in patients who subsequently underwent diagnostic injections to determine the source of chronic LBP were included resulting in 158 unique cases for analysis.
Patients underwent either dual diagnostic facet joint blocks, intra-articular diagnostic sacroiliac joint injections, provocation lumbar discography, or anesthetic injection into putatively painful interspinous ligaments/opposing spinous processes/posterior fusion hardware. If the initial diagnostic procedure was negative, the next most likely structure in the diagnostic algorithm was interrogated. Subsequent diagnostic procedures were not performed after the source of chronic LBP was identified.
The source of chronic LBP was diagnosed as discogenic pain (DP), facet joint pain (FJP), sacroiliac joint pain (SIJP), or other sources of chronic LBP.
Based on a Fisher's exact test, there was marginal evidence the distribution of the source of chronic LBP differed for those with and without a history of SD (P = 0.080). Post-hoc comparisons suggested that patients with a history of SD have a higher probability of DP compared to those without a history of SD (82% versus 41%; P = 0.011). Differences in the probability of FJP, SIJP, or other sources between the SD history groups were not significant.
Small sample size, restrospective design, and possible false-positive results.
This is the first published investigation of the tissue source of chronic LBP after SD. It appears that DP is the most common reason for chronic LBP after SD. If more rigorous study confirms our findings, future biologic treatments may hold value in repairing symptomatic annular fissures after SD.
手术切除椎间盘突出术后反复发作或持续性腰痛（LBP）已有充分记录。这些患者腰痛的来源尚未检查。
比较有和无手术椎间盘切除术（SD）史患者慢性 LBP 源的分布。
回顾性图表审查。
学术脊柱中心。
对 358 例连续患者的图表进行了回顾。对随后接受诊断性注射以确定慢性 LBP 源的患者的 SD 缺失/存在情况进行了记录，纳入了 158 例独特的病例进行分析。
患者接受双诊断关节突关节阻滞、关节内诊断性骶髂关节注射、诱发性腰椎间盘造影术或潜在疼痛棘间韧带/对侧棘突/后路融合硬件的麻醉注射。如果初始诊断程序为阴性，则在下一个诊断算法中检查最可能的结构。在确定慢性 LBP 的来源后，不再进行后续诊断程序。
慢性 LBP 的来源诊断为椎间盘源性疼痛（DP）、关节突关节疼痛（FJP）、骶髂关节疼痛（SIJP）或其他慢性 LBP 来源。
根据 Fisher 精确检验，有证据表明有和无 SD 史患者慢性 LBP 的来源分布不同（P = 0.080）。事后比较表明，有 SD 史的患者 DP 的可能性高于无 SD 史的患者（82%比 41%；P = 0.011）。SD 病史组之间 FJP、SIJP 或其他来源的差异无统计学意义。
样本量小、回顾性设计和可能的假阳性结果。
这是首次发表的关于 SD 后慢性 LBP 组织来源的研究。似乎 DP 是 SD 后慢性 LBP 的最常见原因。如果更严格的研究证实了我们的发现，未来的生物治疗可能在修复 SD 后的症状性环形裂孔方面具有价值。
