Results of surgery for discogenic low back pain: a randomized study using discography versus discoblock for diagnosis.
Results of surgery for discogenic low back pain: a randomized study using discography versus discoblock for diagnosis.
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DOI：
10.1097/brs.0b013e3181a401bf
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发表时间：
2009-06-01
期刊：
影响因子：
3
通讯作者：
Takahashi, Kazuhisa
中科院分区：
文献类型：
--
作者：
Ohtori, Seiji;Kinoshita, Tomoaki;Takahashi, Kazuhisa
研究设计：随机对照研究。目的：评估椎间盘造影和椎间盘阻滞对椎间盘源性腰痛 (LBP) 的诊断。背景资料摘要：椎间盘源性腰痛通常通过磁共振成像和椎间盘造影诊断。然而，唱片记录的可靠性存在争议。之前，我们报道了discoblock与布比卡因在诊断中的有用性，discoblock改善了前路椎间融合手术的结果。然而，该研究不是一项随机对照研究。因此，本研究的目的是比较椎间盘造影和discoblock诊断LBP后的手术结果。 方法：磁共振成像显示L4-L5或L5-S1椎间盘退变的严重LBP患者（n = 42）通过椎间盘造影（1.5 mL造影剂）或discoblock（椎间盘内注射0.75 mL 0.5%布比卡因）进行评估。我们依次对患者进行随机分组。对诊断程序有反应的患者进行了前路椎间盘切除术和椎间融合术。记录并比较组间视觉模拟量表评分（0，无痛；100，最痛）、日本骨科协会评分（0，最痛；3，无痛）、Oswestry 残疾指数以及术前和术后 3 年的患者满意度。 结果：12 名患者未出现椎间盘造影引起的疼痛或通过 discoblock 缓解疼痛，因此被排除。对 15 名通过椎间盘造影显示疼痛激发的患者和 15 名通过椎间盘阻滞缓解疼痛的患者进行了评估。从基线到术后 3 年，discoblock 组的视觉模拟量表评分、日本骨科协会评分和 Oswestry 残疾指数评分的改善率均显着高于椎间盘造影组 (P < 0.05)。椎间盘造影后有 3 名患者对手术不满意，而椎间盘阻滞后有 1 名患者对手术不满意。结论：与椎间盘造影相比，向疼痛的椎间盘注射少量布比卡因后疼痛缓解是诊断椎间盘源性 LBP 的有用工具。
STUDY DESIGN: Randomized, controlled study.OBJECTIVE: To evaluate the diagnosis of discogenic low back pain (LBP) with discography and discoblock.SUMMARY OF BACKGROUND DATA: Discogenic LBP is usually diagnosed by magnetic resonance imaging and discography. However, the reliability of discography is controversial. Previously, we reported the usefulness of discoblock with bupivacaine for diagnosis, and discoblock improved the results of anterior interbody fusion surgery. However, that study was not a randomized, controlled study. Therefore, the purpose of the current study was to compare the results of surgery after diagnosis of LBP by discography and discoblock.METHODS: Patients (n = 42) with severe LBP showing L4-L5 or L5-S1 disc degeneration on magnetic resonance imaging were evaluated by discography (1.5 mL of contrast medium) or discoblock (intradisc injection of 0.75 mL of 0.5% bupivacaine). We randomized the patients in turn. Anterior discectomy and interbody fusion were performed in patients who responded to the diagnostic procedures. The visual analogue scale score (0, no pain; 100, worst pain), Japanese Orthopedic Association Score (0, worst pain; 3, no pain), Oswestry Disability Index, and patient satisfaction before and 3 years after surgery were recorded and compared between groups.RESULTS: Twelve patients did not show pain provocation by discography or pain relief by discoblock and were excluded. Fifteen patients who showed pain provocation by discography and 15 patients who experienced pain relief with discoblock were evaluated. Rates of improvement in the visual analogue scale score, Japanese Orthopedic Association Score, and Oswestry Disability Index score in the discoblock group were significantly higher than those in the discography group (P < 0.05) from baseline to 3 years after surgery. Three patients were dissatisfied with surgery after discography compared with one patient after discoblock.CONCLUSION: Pain relief after injection of a small amount of bupivacaine into the painful disc was a useful tool for the diagnosis of discogenic LBP compared with discography.