Lehmer S M, Dawson M H, O'Brien J P
Sierra Spine Institute, Roseville, California.
Eur Spine J. 1994;3(1):28-31. doi: 10.1007/BF02428313.
The delayed onset of symptomatic pain following lumbar discography (with no immediate pain response) is described in six patients, five with a minimum 2-year follow-up. It is usually seen in patients with nearly normal disc morphology who have incomplete or discrete annular tears that are not filled at the time of injection. Later (2-12 h in this study), dye leakage occurs through these lesions, thereby precipitating the discogenic pain. This phenomenon may be missed and is probably more common than previously believed due to early discharge from the hospital, the patient expecting discomfort after the invasive study (hence no complaint is made), and the clinician being unaware of this delayed symptom, thereby not asking about it in follow-up. Close patient questioning regarding a delayed onset of symptomatic pain after discography is, therefore, an essential element in diagnostic information following this study.
6例患者描述了腰椎间盘造影术后出现症状性疼痛延迟发作（无即时疼痛反应），其中5例进行了至少2年的随访。这种情况通常见于椎间盘形态近乎正常但存在不完全或离散性环形撕裂的患者，这些撕裂在注射时未被填充。之后（本研究中为2 - 12小时），造影剂通过这些病变渗漏，从而引发盘源性疼痛。由于患者早期出院、患者预期侵入性检查后会不适（因此未提出投诉）以及临床医生未意识到这种延迟症状，所以在随访中未询问，这种现象可能被漏诊，而且可能比之前认为的更为常见。因此，在这项检查后的诊断信息中，密切询问患者关于椎间盘造影术后症状性疼痛延迟发作的情况是一个关键要素。
