Clinical value of provocative discography combined with fully visible percutaneous endoscopic surgery in the diagnosis and treatment of discogenic low back pain

doi:10.3877/cma.j.issn.2095-655X.2019.04.005

Abstract

Abstract:

Objective

To explore the diagnostic methods and analyse the clinical effect of provocative discography combined with fully visible percutaneous endoscopic surgery of discogenic low back pain (DLBP).

Methods

The clinical data of 29 patients diagnosed with DLBP by provocative discography admitted to the department of orthopedics of Jiangsu Province Hospital on Integration of Chinese and Western Medicine from July 2015 to June 2018 were retrospectively analyzed. The patients underwent a fully visible percutaneous endoscopic procedure(disectomy and bipolar annuloplasty). The Visual Analog Scale (VAS) score and Oswestry Disability Index (ODI) score (preoperative, postoperative 1 day, 3 months, 6 months) were evaluated. The clinical global outcomes were assessed on the basis of modified MacNab criteria.

Results

All patients were successfully performed the operation. VAS significantly declined from preoperative (6.62±1.01) to postoperative 1 day (1.53±0.43), 3 months (1.06±0.61) and 6 months (0.71±0.37) (F=132.13, P<0.05). ODI decreased from preoperative (51.11±10.15) to 1 day (14.12±1.43), 3 months(12.98±2.01) and 6 months (10.33±1.46) (F=293.35, P<0.05). At the last follow-up, 22 cases of the MacNab results were excellent, 5 cases were good, 2 cases were fair, and none was bad, and the excellent-to-good rate was 93.10%(27/29).

Conclusion

With fewer complications and a lower risk, provocative discography combined with fully visible percutaneous endoscopic surgery is safe and efficacious in the treatment of DLBP.

Key words: Discogenic low back pain, Discography, Endoscopy

Zhipeng Xi, Jingchi Li, Ran Kang, Shibing Zhang, Lin Xie. Clinical value of provocative discography combined with fully visible percutaneous endoscopic surgery in the diagnosis and treatment of discogenic low back pain[J]. Chinese Journal of Diagnostics(Electronic Edition), 2019, 07(04): 239-243.

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References 28

[1]	Peng BG.Pathophysiology，diagnosis，and treatment of discogenic low back pain[J]．World J Orthop，2013，4(2):42-52.
[2]	Moneta GB, Videman T, Kaivanto K，et al.Reported pain during lumbar discography as a function of anular ruptures and disc degeneration.A re-analysis of 833 discograms[J]．Spine (Phila Pa 1976)，1994，19(17):1968-1974.
[3]	Kloth DS, Fenton DS, Andersson GB，et al.Intradiscal electrothermal therapy (IDET) for the treatment of discogenic low back pain：patient selection and indications for use[J]．Pain Physician，2008，11(5):659-668.
[4]	Peng B, Hao J, Hou S, et al. Possible pathogenesis of painful intervertebral disc degeneration[J]．Spine (Phila Pa 1976)，2006，31(5):560-566.
[5]	Freemont AJ, Peacock TE, Goupille P，et al.Nerve ingrowth into diseased intervertebral disc in chronic back pain[J]．Lancet，1997，350(9072):178-181.
[6]	Centerville OH, Niagara WI, Spine A, et al. An update of the systematic appraisal of the accuracy and utility of discography in chronic spinal pain[J]．Pain Physician，2018，21(2):91-110.
[7]	Andersson GB, Mekhail NA, Block JE.Treatment of intractable discogenic low back pain：a systematic review of spinal fusion and intradiscal electrothermal therapy (IDET)[J]．Pain Physician，2006，9(3):237-248.
[8]	Archavlis E, Carvi y Nievas M．Comparison of minimally invasive fusion and instrumentation versus open surgery for severe stenotic spondylolisthesis with high-grade facet joint osteoarthritis[J]．Eur Spine J，2013，22(8):1731-1740.
[9]	Bono CM, Harris MB, Warholic N, et al. Pain intensity and patients acceptance of surgical complication risks with lumbar fusion[J]．Spine (Phila Pa 1976)，2013，38(2):140-147.
[10]	Kjeldsen HB, Klausen TW, Rosenberg J．Preferred presentation of the visual analog scale for measurement of postoperative pain[J]．Pain Practice，2016，16(8):980-984.
[11]	Fairbank JC.Oswestry disability index[J]．J Neurosurg Spine，2014，20(2):239-241.
[12]	Macnab I．Negative disc exploration. An analysis of the causes of nerve-root involvement in sixty-eight patients[J]．J Bone Joint Surg Am，1971，53(5):891-903.
[13]	潘祥林，王涓冬，赵华．临床诊断思维[J/CD]．中华诊断学电子杂志，2015，3(2):84-85.
[14]	Aprill C, Bogduk N．High-intensity zone：a diagnostic sign of painful lumbar disc on magnetic resonance imaging[J]．Br J Radiol，1992，65(773):361-369.
[15]	Carragee EJ, Paragioudakis SJ, Khurana S. 2000 Volvo Award winner in clinical studies：lumbar high-intensity zone and discography in subjects without low back problems[J]．Spine (Phila Pa 1976)，2000，25(23):2987-2992.
[16]	Kluner C, Kivelitz D, Rogalla P，et al.Percutaneous discography：comparison of low-dose CT，fluoroscopy and MRI in the diagnosis of lumbar disc disruption[J]．Eur Spine J，2006，15(5):620-626.
[17]	Margetic P, Pavic R, Stancic MF.Provocative discography screening improves surgical outcome[J]．Wien Klin Wochenschr，2013，125(19/20):600-610.
[18]	Gill K, Blumenthal SL. Functional results after anterior lumbar fusion at L5-S1 in patients with normal and abnormal MRI scans[J]．Spine (Phila Pa 1976)，1992，17(8):940-942.
[19]	Fritzell P, Hägg O, Wessberg P, et al. Lumbar fusion versus nonsurgical treatment for chronic low back pain：a multicenter randomized controlled trial from the Swedish Lumbar Spine Study Group[J]．Spine (Phila Pa 1976)，2001，26(23):2521-2532.
[20]	Ohtori S, Koshi T, Yamashita M，et al.Surgical versus nonsurgical treatment of selected patients with discogenic low back pain：a small-sized randomized trial[J]．Spine (Phila Pa 1976)，2011，36(5):347-354.
[21]	Bogduk N, Aprill C, Derby R．Lumbar discogenic pain：state-of-the-art review[J]．Pain Med，2013，14(6):813-836.
[22]	Ilhan S, Ozturk I．The effect of intradiscal electrothermal therapy on quality of life and satisfaction of patients with discogenic low back pain[J]．Eurasian J Med，2017，1(2):101-105.
[23]	Desai MJ, Kapural L, Petersohn JD，et al.Twelve-month follow-up of a randomized clinical trial comparing intradiscal biacuplasty to conventional medical management for discogenic lumbar back pain[J]．Pain Med，2017，18(4):751-763.
[24]	Liliang PC, Lu K, Liang CL，et al.Nucleoplasty for treating lumbar disk degenerative low back pain：an outcome prediction analysis[J]．J Pain Res，2016(9):893-898.
[25]	Cheng J, Zheng W, Wang H, et al. Posterolateral transforaminal selective endoscopic diskectomy with thermal annuloplasty for discogenic low back pain：a prospective observational study[J]．Spine (Phila Pa 1976)，2014(39):60-65.
[26]	Pan F, Shen B, Chy SK，et al.Transforaminal endoscopic system technique for discogenic low back pain：a prospective cohort study[J]．Int J Surg，2016(35):134-138.
[27]	Pan Z, Ha Y, Yi S，et al.Efficacy of transforaminal endoscopic spine system (TESSYS) technique in treating lumbar disc herniation[J]．Med Sci Monit，2016(22):530-539.
[28]	Liu KC, Yang SK, Ou BR.Using percutaneous endoscopic outside-in technique to treat selected patients with refractory discogenic low back pain[J]．Pain Physician，2019，22(2):187-198.

项目	例数	术前	术后1 d	术后3个月	术后6个月	F值	P值
VAS评分	29	6.62±1.01	1.53±0.43^a	1.06±0.61^a	0.71±0.37^a	132.13	<0.01
ODI评分	29	51.11±10.15	14.12±1.43^a	12.98±2.01^a	10.33±1.46^a	293.35	<0.01

项目	例数	术前	术后1 d	术后3个月	术后6个月	F值	P值
VAS评分	29	6.62±1.01	1.53±0.43^a	1.06±0.61^a	0.71±0.37^a	132.13	<0.01
ODI评分	29	51.11±10.15	14.12±1.43^a	12.98±2.01^a	10.33±1.46^a	293.35	<0.01

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