Sacroiliac joint pain after lumbar fusion. A study with anesthetic blocks

Low back pain persisting or appearing after a technically successful lumbar fusion challenges clinicians. In this context, the sacroiliac joint could be a possible source of pain, but the frequency of its responsibility is not really known. We used sacroiliac anesthetic blocks, the gold standard for diagnosis, to determine this frequency. Our second goal was to search predictive factors for a positive block. Our prospective series consisted of 40 patients with persistent low back pain after a technically successful fusion who received a sacroiliac anesthetic block under fluoroscopic control. The diagnostic criterion was a relief of more than 75% of the pain on a visual analog scale. We found a 35% rate of positive blocks. The only criterion that characterized these patients was a postoperative pain different from the preoperative pain in its distribution ( p =0.017). A free interval of more than 3 months between surgery and appearance of the pain had an indicative value ( p =0.17). An increased uptake in the sacroiliac on bone scintigraphy or a past history of posterior iliac bone-graft harvesting had no significant value ( p =0.74 and p =1.0, respectively). The sacroiliac joint is a possible source of pain after lumbar fusion. The anesthetic block under fluoroscopic control remains the gold standard.     

经颅磁刺激运动诱发电位在腰椎管狭窄症临床评价中的应用价值

目的 分析经颅磁刺激运动诱发电位(motor evoked potentials,MEP)在腰椎管狭窄症临床评价中的应用价值.方法 23例腰椎管狭窄患者,男12例,女11例;年龄52～83岁,平均67.9岁.单纯腰椎管狭窄症11例,合并腰椎退变性滑脱12例.就诊时平均病程31.5个月(3个月～10年).出现单侧下肢症状者(疼痛或麻木、无力)9例,双下肢均出现者14例.所有患者均合并间歇性跛行,出现跛行前平均行走距离为302.1 m(3～1000 m).MRI中最狭窄节段的硬膜囊向积值(minimum cross-sectional area, MCSA)平均0.4 cm2(0.1～0.9 cm2).于患者双侧(足母)内收肌处记录经颅磁刺激MEP潜伏期(MEP latency,MEPLT),同时收集患者治疗前JOA评分、视觉模拟评分(VAS,包括腰痛,下肢、臀部痛及麻木程度).采用SPSS 12.0软件进行统计学分析.结果 MEPLT为(42.1±2.8)ms,JOA评分为(15.9±4.8)分.腰痛、下肢及臀部痛、下肢及臀部麻木感VAS分别为(6.0±2.9)分、(7.7±1.9)分、(7.3±3.0)分.MEPLT与步行距离、下肢症状类型及麻木VAS存在相关.步行距离＜500 m者MEPLT明显延长(t=3.529,P＜0.05).结论 MEPLT延长在腰椎管狭窄患者出现临床体征之前即可出现,MEP可有效反映患者的主观症状.     

42例腰椎融合术后难治性下腰痛的治疗体会

目的探讨腰椎融合术后骶髂关节病变的特点及治疗方法与疗效。方法回顾性分析42例因腰椎退变性滑脱、腰椎椎间盘突出、腰椎椎管狭窄曾行后路减压、后外侧或椎体间植骨融合及椎弓根内固定术,术后随访12～72个月(平均42.6个月)出现新的难治性持续性下腰痛症状的病例。本研究运用骶髂关节内封闭进行诊断性治疗。阳性标准:疼痛缓解≥75%,采用疼痛视觉模拟量表(visual analogue scale,VAS)进行定量分析。结果阳性12例(28.57%),是否融合L5/S1、术后疼痛缓解期是否≥3个月与诊断阳性率相关,有统计学意义(P<0.05)。结论腰椎融合术后下腰痛部分可能是由骶髂关节病变引起的,L5/S1融合可能促进骶髂关节发生退变。症状以下腰痛症状为主者,手术应慎重。     

Sacroiliac joint dysfunction in patients with imaging-proven lumbar disc herniation

A dysfunction of a joint is defined as a reversible functional restriction of motion presenting with hypomobility according to manual medicine terminology. The aim of our study was to evaluate the frequency and significance of sacroiliac joint (SIJ) dysfunction in patients with low back pain and sciatica and imaging-proven disc herniation. We examined the SIJs of 150 patients with low back pain and sciatica; all of these patients had herniated lumbar disks, but none of them had sensory or motor losses. Forty-six patients, hereinafter referred to as group A, were diagnosed with dysfunction of the SIJ. The remaining 104 patients, hereinafter referred to as group B, had no SIJ dysfunction. Dysfunctions were resolved with mobilizing and manipulative techniques of manual medicine. Regardless of SIJ findings, all patients received intensive physiotherapy throughout a 3-week hospitalisation. At the 3 weeks follow-up, 34 patients of group A (73.9%) reported an improvement of lumbar and ischiadic pain, 5 patients were pain free. Improvement was recorded in 57 of the group B patients (54.8%); however, nobody in group B was free of symptoms. We conclude that in the presence of lumbar and ischiadic symptoms our presented data suggest consideration of SIJ dysfunction, requiring manual medicine examination and, in the presence of SIJ dysfunction, appropriate therapy, regardless of intervertebral disc pathomorphology. This could avoid wrong indications for nucleotomy. Received: 27 November 1996 Revised: 10 June 1998 Accepted: 13 July 1998     

Functional and radiographic outcome of sacroiliac arthrodesis for the disorders of the sacroiliac joint.

BACKGROUND CONTEXT: The sacroiliac joint is known to be a possible cause of chronic low back pain, but the diagnosis and treatment of disorders of the sacroiliac joint have been difficult and controversial. PURPOSE: To describe the outcome of sacroiliac joint arthrodesis for sacroiliac joint disorders, with the hypothesis that sacroiliac arthrodesis leads to improved postoperative function. STUDY DESIGN/SETTING: Consecutive case series performed in an academic medical institution. PATIENT SAMPLE: The patient population consisted of 20 patients undergoing sacroiliac joint arthrodesis between December 1994 and December 2001. Patients undergoing concomitant procedures at the time of sacroiliac joint arthrodesis were excluded. The 3 men and 17 women in the study group had an average age of 45.1 years (range 21.8-66.4 years), a mean duration of symptoms of 2.6 years (range 0.5-8.0 years), and a mean follow-up period of 5.8 years (range 2.0-9.0 years). OUTCOME MEASURES: Outcome measures included general health and function, clinical evaluation, and radiographic assessment. METHODS: For all 20 patients, nonoperative treatment had failed, and for all, the diagnosis was confirmed by pain relief with intraarticular sacroiliac joint injections under fluoroscopic guidance. Sacroiliac joint arthrodesis (via a modified Smith-Petersen technique) was recommended only when a positive response to the injection was noted, and patients had recurrence of symptoms after the initial positive response. Preoperative and postoperative general health and function were assessed via the 36-item Short-Form (SF-36) Health Survey and American Academy of Orthopaedic Surgeons (AAOS) Modems Instrument, which were collected prospectively. Medical records and plain radiographs were reviewed retrospectively to determine the clinical and radiographic outcome. RESULTS: Multiple etiologies of sacroiliac symptoms were observed: sacroiliac joint dysfunction (13 patients), osteoarthritis (5 patients), and spondyloarthropathy and sacroiliac joint instability (1 each). Seventeen patients (85%) had solid fusion. Fifteen patients (75%) completed preoperative and postoperative SF-36 forms. Significant (p< or =.05) improvement occurred in the following categories: physical functioning, role physical, bodily pain, vitality, social functioning, role emotional, and neurogenic and pain indices. Improvement (not statistically significant) was also noted in general and mental health. CONCLUSIONS: For carefully selected patients, sacroiliac arthrodesis appears to be a safe, well-tolerated, and successful procedure, leading to significant improvement in functional outcome and a high fusion rate. To the authors' knowledge, the current report is the largest series to document the functional and radiographic outcome of sacroiliac joint arthrodesis.     

Low back pain and its relation to the hip and foot

STUDY DESIGN: Case study. OBJECTIVE: To describe a treatment approach for a patient with recurrent low back pain who also had asymmetry in hip rotation between the left and right sides. BACKGROUND: The patient's chief complaint was dull, intermittent unilateral low back pain during the past 3 years. METHODS AND MEASURES: The patients was a 35-year-old man with recurrent unilateral low back pain. The findings of the physical therapy examination suggested sacroiliac joint dysfunction. Also, evaluation later showed evidence of unilateral excessive foot pronation on the same side of the excessive hip lateral rotation. The finding of excessive hip lateral rotation and excessive foot pronation on the same side of the unilateral low back pain suggested a possible connection between low back symptoms, hip, and lower extremity dysfunction. RESULTS: The treatment of the hip and the subtalar joint of the foot eliminated the reoccurrence of the patients signs and symptoms of sacroiliac joint dysfunction. CONCLUSIONS: This case report demonstrates the successful treatment of a patient with low back pain who exhibited multiple impairments in the sacroiliac, hip, and subtalar joints.     

骶管注射对无坐骨神经痛性腰椎间盘突出症的疗效分析

目的：观察骶管注射疗法对无坐骨神经痛性腰椎间盘突出症患者的疗效。方法：2010年12月至2011年6月,对就诊的65例经CT或MRI检查证实为腰椎间盘突出或膨出所致的急性腰痛且无下肢放射痛的患者随机分为骶管注射组（试验组）和腰椎斜扳组（对照组）,试验组35例,男30例,女5例,年龄3356岁,平均（43．90±1．14）岁;对照组30例,男27例,女3例,年龄3457岁,平均（44．00±1．19）岁。两组的发病时间为1 h～3 d。分别行骶管注射或腰椎斜扳手法治疗。比较治疗前和治疗后30 min两组的VAS评分。结果：所有患者经治疗后急性腰痛症状明显缓解,骶管注射组和腰椎斜扳组的VAS评分分别从（6．63±0．97）和（6．67±0．96）分减至（3．06±1．51）和（3．93±1．20）分,两种治疗方法均能改善患者VAS评分,但骶管注射组治疗要优于腰椎斜板组（P 0．05）。结论：骶管注射和腰椎斜扳疗法对无坐骨神经痛性腰椎间盘突出症急性腰痛的患者具有快速缓解的作用,且前者的疗效更佳。     

腰椎间盘突出症后路内窥镜髓核摘除联合纤维环缝合术疗效的预测因素分析

目的 研究分析后路内窥镜髓核摘除(microendoscopy discectomy,MED)联合纤维环缝合术预后良好的相关因素.方法 纳入本科自2016年8月～2019年8月行MED联合纤维环缝合术治疗的133例腰椎间盘突出症(Lumbar disc herniation,LDH)患者,按"预后良好标准"(腰痛VAS...     

Facet joint degeneration as a cause of low back pain

Recognizing that not all patients with low back pain have lumbar disc disease, the authors began to inject facet joints in June 1982 and have experience now with 21 patients, each injected under fluoroscopic control with a mixture of local anesthetic and steroid. One technical problem occurred when large osteophytes blocked access to the facet joints. Otherwise, there were no complications and minimal morbidity. Most patients (15 of 20; 75%) had an initial response, but a much smaller number (six of 18 followed more than three months; 33%) had a lasting response. Repeat injections, when done, always led to temporary improvement but rarely to lasting relief (one of five; 20%). Three factors characterized the patients: a negative screening examination for other causes of back pain or sciatica; back pain with tenderness localized over one or more facet joints; and radiologic changes of degenerative joint disease within the facet joints. Facet joint disease may be a significant cause of low back pain. The above three criteria are useful in clinical identification of patients with this problem. Facet joint injections play an important role in the diagnosis and treatment of low back pain.     

潜行减压单侧改良TLIF手术治疗腰椎退行性疾患的初步疗效

目的：观察椎管潜行减压单侧改良经椎间孔腰椎间融合术（transforaminal lumbar interbody fusion,TLIF）手术治疗腰椎退行性疾病的临床疗效。方法：自2009年8月至2011年12月,采用椎管潜行减压单侧改良TLIF手术治疗腰椎退行性疾病患者28例,其中男16例,女12例;年龄46-71岁,平均61岁;病程6个月-6年。腰椎管狭窄症20例,腰椎间盘突出症8例。潜行减压范围：单节段24例,双节段4例。左侧15例,右侧13例。采用JOA下腰痛评分系统（29分）评价手术前后临床症状、体征及括约肌功能;并采用视觉模拟评分（VAS）评估手术前后腰腿痛情况。结果：28例患者获随访,时间6-28个月,平均14个月。术后JOA、VAS评分（17.9±2.2、2.8±0.7）与术前（8.5±1.7、8.6±1.2）比较有明显改善（P〈0.05）。28例患者椎间均达到骨性融合。结论：采用椎管潜行减压单侧改良TLIF手术治疗单侧根性症状的腰椎管狭窄症、腰椎间盘突出症,具有创伤小、疗效确切的优点;能明显节省医疗费用,值得临床研究推广。     

椎弓根固定结合经椎间孔椎间融合治疗复发性腰椎间盘突出症伴腰椎不稳

目的：探讨经肌间隙入路椎弓根固定结合经椎间孔椎间融合（transforaminal lumbar interbody fusion,TLIF）治疗复发性腰椎间盘突出症伴腰椎不稳的临床疗效。方法：2008年3月至2010年5月收治35例复发性腰椎间盘突出症,其中15例行经肌间隙入路单边椎弓根固定结合TLIF术式（单边固定组）,20例行后正中入路双边椎弓根固定结合后路椎间植骨融合（posterior lumbar interbody fusion,PLIF）术式（双边固定组）.观察手术时间、术中出血量,并比较手术前后两组患者JOA评分、腰痛及腿痛VAS评分及融合情况。结果：所有患者获得随访,时间6～30个月,平均16.8个月。两组患者腰腿痛等临床症状较术前明显缓解,X线片显示植骨融合良好（双边固定组中1例未融合）,无融合器移位、下沉及内固定器械松动或断裂。两组患者手术时间、术中出血量比较差异有统计学意义（P<0.05）.术后JOA评分均较术前降低（P<0.05）.术后1周,两组患者腰痛VAS评分比较差异有统计学意义（P<0.05）,腿痛VAS评分比较差异无统计学意义（P>0.05）;末次随访,腰痛及腿痛VAS评分两组比较差异无统计学意义（P>0.05）.结论：两种术式在治疗复发性腰椎间盘突出症伴腰椎不稳均可达到满意的疗效,经肌间隙入路单边椎弓根固定结合TLIF术式切口较小,手术时间较短,术中出血量较少,术后腰痛缓解较快。     

Computed tomography findings in patients with sacroiliac pain

This retrospective study evaluated the diagnostic value of computed tomography in patients with sacroiliac pain. Computed tomography scans of the sacroiliac joints of 62 patients with sacroiliac joint pain were reviewed. The criteria to include the patient in the current study were pain relief after a local injection in the sacroiliac joint under computed tomography guidance, a physical examination consistent with a sacroiliac origin of the pain, and negative magnetic resonance imaging of the lumbar spine. A control group consisted of 50 patients of matched age who had computed tomography scans of the pelvis for a reason other than pelvic or back pain. Computed tomography scans showed one or more findings in 57.5% and 31% of the sacroiliac joints in the symptomatic and the control groups, respectively. The computed tomography scans were negative in 37 (42.5%) symptomatic sacroiliac joints with a positive sacroiliac joint injection test. The sensitivity of computed tomography was 57.5 % and its specificity was 69%. The finding of the current study suggests limited diagnostic value of computed tomography in sacroiliac joint disease because of its low sensitivity and specificity. With clinical suspicion of a sacroiliac origin of pain, intraarticular injection is currently the only means to confirm that diagnosis.     

腰椎融合术后骶髂关节源性下腰痛的诊断和治疗

目的探讨腰椎融合术后骶髂关节病变的特点、治疗方法与疗效。方法回顾性分析34例因腰椎管狭窄、腰椎间盘突出、腰椎滑脱曾行后路减压、后外侧或椎体间植骨融合及椎弓根内固定术,术后随访12～48个月（平均30．6个月）出现新的难治性持续性下腰痛症状的病例。运用骶髂关节内封闭进行诊断性治疗。阳性标准：疼痛缓解75％（采用视觉模拟评分法进行定量分析）。结果阳性率为26．5％,术后腰痛部位不同于术前以及融合范围包含L5、S1是具有统计学意义（P〈0．05）。结论腰椎融合术后下腰痛可能部分是由骶髂关节病变引起的,骶髂关节内封闭是当前诊断和治疗骶髂关节源性下腰痛的最有效的方法。     

骶髂关节紊乱与腰椎间盘退变之间相关性的流行病学研究与生物力学分析

目的：研究骶髂关节紊乱与腰椎间盘退变之间的相关性,为慢性顽固性腰腿痛的防治提供一个新的认识理念和临床治疗途径。方法：自2009年8月至2010年10月,采用流行病学调查的方法研究129例腰椎间盘突出症患者。L4.5椎间盘突出症患者61例,男37例,女24例;年龄20～75岁;病程1～144个月。L5S1椎间盘突出症患者68例,男32例,女36例;年龄18～76岁;病程0．5～240个月。流行病学调查患者的一般临床资料、症状与体征,以及腰椎与骨盆在X线片的表现形式。病例对照研究的方法计算骶髂关节紊乱对腰椎间盘突出症发病的危险度;单因素危险度估计对自变量进行筛选,Logistic回归分析确定腰椎间盘突出症的危险因素,并进行生物力学分析。结果：129例腰椎间盘突出症患者中88例合并有骶髂关节紊乱,骶髂关节紊乱是腰椎间盘突出的危险因素之一（OR=4．61,P=0．00）;61例L5S1椎间盘突出症患者中47例合并骶髂关节紊乱,髂骨旋转移位引起的髂嵴不平为L4．,椎间盘突出症的高危险因素（OR=11．27,P=0．00）;68例L5S1椎间盘突出症患者中41例合并骶髂关节紊乱,骶骨倾斜移位引起的腰骶角异常为L5S1椎间盘突出症的高危险因素（OR=2．31,P=O．03）。结论：骶髂关节紊乱与腰椎间盘突出症是二联症,二者相互影响且有因果关系,任何一方的发生是另一方发生的原因和结果,共同存在于腰腿痛疾病中。     

微创单侧椎弓根螺钉固定、椎体间融合治疗腰椎疾患所致腰痛的临床观察

目的:评价微创单侧椎弓根螺钉固定、椎间融合治疗腰椎疾患所致腰痛的临床疗效。方法:2003年12月～2006年8月,共收治不同原因所致腰痛患者29例,其中腰椎间盘突出症13例,腰椎不稳8例,椎间盘源性腰痛5例,MED术后复发3例,均采用可扩张管道系统经椎间孔行椎体间植骨融合、单侧椎弓根螺钉固定术治疗。应用视觉模拟评分系统(VAS)评估患者术前、术后疼痛情况,应用Kim方法评价临床效果,应用Schulte方法观察植骨融合情况。结果:1例患者术后出现对侧下肢放射性疼痛,保守治疗无效,再次手术行神经根管减压和内固定后症状缓解。随访21～36个月,平均31.5个月,术前VAS评分为7.7±0.6分,术后3个月时为1.9±0.9分,两者比较有显著性差异(P0.001),术后3个月时Kim优良率为89.7%,末次随访时Kim优良率为96.6%,满意率为96.6%。末次随访时椎间融合率为93.1%,1例可能融合和1例假关节形成。结论:微创单侧椎弓根螺钉固定是治疗腰痛的一种有效方法,但需要严格把握手术适应证。     

Epidural neuroplasty versus physiotherapy to relieve pain in patients with sciatica: a prospective randomized blinded clinical trial

Background Epidural neuroplasty seems to be one of the promising minimally invasive techniques for adhesiolysis in patients with chronic sciatica with or without low back pain. However, because no data exist from randomized studies the aim was to investigate whether this procedure is superior to conservative treatment with physiotherapy. Methods A total of 99 patients with chronic low back pain were enrolled in this study and randomly assigned into either a group with physiotherapy (n = 52) or a second group undergoing epidural neuroplasty (n = 47). Patients were assessed before and 3, 6, and 12 months after treatment by a blinded investigator. Results After 3 months, the visual analog scale (VAS) score for back and leg pain was significantly reduced in the epidural neuroplasty group, and the need for pain medication was reduced in both groups. Furthermore, the VAS for back and leg pain as well as the Oswestry disability score were significantly reduced until 12 months after the procedure in contrast to the group that received conservative treatment. Conclusions Epidural neuroplasty results in significant alleviation of pain and functional disability in patients with chronic low back pain and sciatica based on disc protrusion/prolapse or failed back surgery on a short-term basis as well as at 12 months of follow-up.     

腰椎间盘内破裂的诊断和治疗

目的　研究腰椎间盘内破裂的诊断和治疗方法。　方法　 36例慢性失能性下腰痛病人 ,经腰椎间盘造影术证实为腰椎间盘内破裂 ,选择腰椎体间融合术 ,其中 8例行后路椎体间植骨融合椎弓根螺钉系统内固定术 (PLIF) ,2 8例行前路髓核摘除植骨融合术 (ALIF)。分别于术前、术后对病人的腰痛情况进行视觉疼痛自我评定尺 (VAS)评分 ,同时评估术后腰椎融合率。　结果　术后随访时间 6～ 2 6个月 ,平均 18个月。 8例行PLIF者 ,6例术后腰腿痛症状基本消失 ,2例仍有轻度腰痛 ,术前、术后VAS腰痛评分 ,差异有非常显著性意义 (P <0 0 1)。 2 8例行ALIF者 ,2 7例腰腿痛症状基本消失 ,术前、术后VAS腰痛评分 ,有非常显著性差异 (P <0 0 1)。行PLIF患者 ,融合率为 88% ,行ALIF者 ,融合率达 97%。　结论　腰椎椎体间融合术是治疗腰椎间盘内破裂的有效方法 ,但应严掌握手术适应证     

Systematic review of tests to identify the disc, SIJ or facet joint as the source of low back pain

Clinical practice guidelines state that the tissue source of low back pain cannot be specified in the majority of patients. However, there has been no systematic review of the accuracy of diagnostic tests used to identify the source of low back pain. The aim of this systematic review was therefore to determine the diagnostic accuracy of tests available to clinicians to identify the disc, facet joint or sacroiliac joint (SIJ) as the source of low back pain. MEDLINE, EMBASE and CINAHL were searched up to February 2006 with citation tracking of eligible studies. Eligible studies compared index tests with an appropriate reference test (discography, facet joint or SIJ blocks or medial branch blocks) in patients with low back pain. Positive likelihood ratios (+LR) > 2 or negative likelihood ratios (-LR) < 0.5 were considered informative. Forty-one studies of moderate quality were included; 28 investigated the disc, 8 the facet joint and 7 the SIJ. Various features observed on MRI (high intensity zone, endplate changes and disc degeneration) produced informative +LR (> 2) in the majority of studies increasing the probability of the disc being the low back pain source. However, heterogeneity of the data prevented pooling. +LR ranged from 1.5 to 5.9, 1.6 to 4.0, and 0.6 to 5.9 for high intensity zone, disc degeneration and endplate changes, respectively. Centralisation was the only clinical feature found to increase the likelihood of the disc as the source of pain: +LR = 2.8 (95%CI 1.4–5.3). Absence of degeneration on MRI was the only test found to reduce the likelihood of the disc as the source of pain: −LR = 0.21 (95%CI 0.12–0.35). While single manual tests of the SIJ were uninformative, their use in combination was informative with +LR of 3.2 (95%CI 2.3–4.4) and −LR of 0.29 (95%CI 0.12–0.35). None of the tests for facet joint pain were found to be informative. The results of this review demonstrate that tests do exist that change the probability of the disc or SIJ (but not the facet joint) as the source of low back pain. However, the changes in probability are usually small and at best moderate. The usefulness of these tests in clinical practice, particularly for guiding treatment selection, remains unclear. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

经椎间孔腰椎间融合单侧固定对融合节段对侧结构的影响

目的 研究微创经椎间孔椎体间植骨融合单侧内固定手术对融合节段对侧结构的影响,并探讨术后对侧发生疼痛的原因.方法 回顾性分析2009年1月至2010年1月进行微创经椎间孔减压椎体间植骨融合单侧内固定手术的34例患者.使用疼痛视觉模拟评分(visual analogue scale,VAS)和日本整形外科学会(Japane...     

Effectiveness of L2 spinal nerve infiltration for selective discogenic low back pain patients

Background

It has been reported that rat L5/6 lumbar discs are innervated mainly by L2 dorsal root ganglion neurons. We previously reported that L2 spinal nerve infiltration was effective for discogenic low back pain (DLBP) patients, although the diagnosis was based only on the results of physical examination, plain films, and magnetic resonance imaging (MRI). The purpose of the current study was to evaluate L2 spinal nerve block for DLBP patients retrospectively based on MRI findings and surgical results.

Methods

A total of 62 patients with only LBP and no accompanying radicular pain were investigated. Patients had only one level of disc degeneration on MRI. When pain was provoked during discography, we performed surgery at the next stage (40 patients). In all, 22 patients were excluded owing to negative discography results. Of the 40 patients, we evaluated 25 strictly selected patients suffering from DLBP. DLBP was diagnosed when the patient experienced pain relief at least 2 years after anterior lumbar interbody fusion. Fifteen patients who did not show pain relief after surgery were used for the non-DLBP group. L2 spinal nerve infiltration using 1.5 ml of lidocaine was performed in all 40 patients before surgery. The visual analogue scale (VAS) score after L2 spinal nerve infiltration was recorded, and an association of L2 spinal nerve infiltration and DLBP was explored.

Results

Low back pain scores assessed using the VAS score, the Japanese Orthopedic Association score, and the Oswestry Disability Index score in the two groups were not significantly different. L 2 spinal nerve infiltration was effective for 27 patients but not effective for 13 patients; the VAS score after 15 min and 2 h improved in the DLBP group compared with that of the non-DLBP group (P < 0. 05). L2 spinal nerve infiltration was more effective in DLBP patients (21 patients, 84%) than in the non-DLBP group (6 patients, 40%) (P < 0.05).

Conclusions

In the current study, L2 spinal nerve infiltration was effective in 84% of selected DLBP patients and is thought to be a useful tool for diagnosing DLBP. However, we should take into consideration that the L2 spinal nerve infiltration was effective in 40% of non-DLBP patients as well.