| TITLE: | Outcome of unoperated discogram-positive low back pain [see comments] |
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| AUTHOR: | Smith SE; Darden BV; Rhyne AL; Wood KE |
| AUTHOR AFFILIATION: | Charlotte Spine Center, North Carolina, USA. |
| SOURCE: | Spine 1995 Sep 15;20(18):1997-2000; discussion 2000-1 |
| CITATION IDS: | PMID: 8578375 UI: 96093344 |
| COMMENT: | Comment in: Spine 1996 Jun 1;21(11):1394-5 |
| ABSTRACT: | STUDY DESIGN: No previous discography study has addressed the nonoperative outcome of low back pain. OBJECTIVES: This study was undertaken to retrospectively analyze the outcome of patients with documented single-level discogenic pain who were considered candidates for surgery but did not receive it. SUMMARY OF BACKGROUND DATA: The natural history of "discogenic" low back pain is unknown, and its treatment is controversial. Although positive discography is viewed as a valid diagnostic technique, the results of fusion surgery are often disappointing. METHOD: Twenty-five individuals (16 women, 9 men) underwent comprehensive evaluation (examination, radiography, objective disability determination). Study criteria included incapacitating low back pain, single-level + morphologic + provocative discogram, no surgery, and a minimum follow-up period of 3 years. RESULTS: Average age of patients at discography was 43 years and at study was 48 years; level of involvement in 10 patients was L4-L5 and in 15 patients were L5-S1. The mean follow-up period was 4.9 years (range, 3.3-7.0 years). The condition of 17 (68%) patients improved, two (8%) stayed the same, and six (24%) worsened. Improved patients had a shorter history of low back pain (3.5 yr vs. 11.0 yr) and older age at onset (45 versus 33 yrs.) Psychiatric disease was present in 66.7% (4 of 6) patients whose conditions worsened. Eighty percent (12 of 15) of patients receiving workers' compensation improved. There was no correlation between disc level, gender, smoking, and outcome. CONCLUSIONS: Discogenic low back pain improved in patients without psychiatric disease. Older age at onset and shorter duration of low back pain were favorable indicators. These results are comparable with or better than those reported for surgical treatment of this condition. |
| MAIN MESH HEADINGS: | Intervertebral Disk Displacement/*radiography Low Back Pain/*radiography Lumbar Vertebrae/*radiography |
| ADDITIONAL MESH HEADINGS: | Adult Disability Evaluation Female Follow-Up Studies Human Intervertebral Disk Displacement/complications Intervertebral Disk Displacement/therapy Low Back Pain/etiology Low Back Pain/therapy Male Middle Age Retrospective Studies Treatment Outcome |
| PUBLICATION TYPES: | JOURNAL ARTICLE |
| LANGUAGE: | Eng |
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