Shah Bunty, Vorobeychik Yakov
Department of Anesthesiology and Perioperative Medicine, Penn State M.S. Hershey Medical Center, 500 University Dr. Hershey, PA, 17033, USA.
Interv Pain Med. 2025 Jul 3;4(3):100609. doi: 10.1016/j.inpm.2025.100609. eCollection 2025 Sep.
The previously described posterior ligamentous complex inflammatory syndrome can result in chronic axial low back pain. This condition can be identified through MRI findings that demonstrate inflammatory changes in the compartments of the posterior ligamentous complex region, with the space of Okada serving as a connection between them. However, an effective interventional treatment for this syndrome has not yet been proposed.
We present the case of a patient suffering from persistent axial low back pain who did not respond to medication or physical therapy. A SPECT scan revealed significant radiotracer uptake in the bilateral L4-L5 facet joints and the L4-L5 interspinous ligament. Given that bilateral L3-L4 diagnostic medial branch blocks yielded negative results, posterior ligamentous complex inflammatory syndrome was suspected. Injection of contrast dye into the L4-L5 interspinous adventitial bursa demonstrated the spread of contrast material from the injection site to the space of Okada and the bilateral L4-L5 facet joints. Subsequent steroid injection provided the patient with over 80 % pain relief at the five-week follow-up.
Patients experiencing axial low back pain, particularly those with negative diagnostic medial branch blocks, should consider undergoing a SPECT scan. This recommendation is particularly relevant in cases involving Baastrup disease or pars defects, as these conditions are often associated with the presence of the space of Okada, which is crucial for the development of PLCIS. If this diagnosis is confirmed through imaging, a steroid injection into the adventitial interspinous bursa may offer an effective treatment for PLCIS by facilitating medication distribution throughout the compartments of the posterior ligamentous complex region.
先前描述的后韧带复合体炎症综合征可导致慢性下腰部轴向疼痛。这种情况可通过磁共振成像（MRI）检查结果来识别，该结果显示后韧带复合体区域各腔室存在炎症变化，冈田间隙是它们之间的连接部位。然而，尚未提出针对该综合征的有效介入治疗方法。
我们报告一例持续性下腰部轴向疼痛患者，其对药物治疗和物理治疗均无反应。单光子发射计算机断层扫描（SPECT）显示双侧L4-L5小关节和L4-L5棘间韧带放射性示踪剂摄取显著。鉴于双侧L3-L4诊断性内侧支阻滞结果为阴性，怀疑为后韧带复合体炎症综合征。向L4-L5棘间外膜囊内注射造影剂显示造影剂从注射部位扩散至冈田间隙和双侧L4-L5小关节。随后进行类固醇注射，在五周随访时患者疼痛缓解超过80%。
患有下腰部轴向疼痛的患者，尤其是诊断性内侧支阻滞结果为阴性的患者，应考虑进行SPECT扫描。这一建议在涉及巴斯楚普病或椎弓峡部裂的病例中尤为重要，因为这些情况通常与冈田间隙的存在有关，而冈田间隙对后韧带复合体炎症综合征的发生发展至关重要。如果通过影像学检查确诊，向棘间外膜囊内注射类固醇可能通过促进药物在整个后韧带复合体区域各腔室的分布，为后韧带复合体炎症综合征提供有效的治疗方法。
