Related Experiment Video
Updated: Jun 7, 2026
11:30
Multilevel Oblique Lumbar Interbody Fusion in Degenerative Lumbar Disc Disease with Instability
Published on: July 25, 2025
Provocation lumbar diskography at previously fused levels.
H S Dulai1, W S Bartynski, W S Rothfus
1Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA.
Summary
Recurrent low back pain after lumbar fusion may stem from the fused or adjacent disc levels. Lidocaine-assisted provocation lumbar diskogram (PLD) can identify these diskogenic pain sources, guiding treatment effectively.
Area of Science:
- Spine surgery
- Pain management
- Diagnostic imaging
Background:
- Recurrent or persistent low back pain (LBP) is a common complication after lumbar fusion surgery.
- Identifying the precise source of LBP in these cases can be challenging.
- Previous lumbar fusion may be technically successful, yet pain persists.
Purpose of the Study:
- To evaluate provocation lumbar diskogram (PLD) features in patients with recurrent/persistent LBP post-lumbar fusion.
- To assess the outcome of revision surgery (redo-fusion) in this patient cohort.
- To determine if PLD can confirm diskogenic pain at fused or adjacent levels.
Main Methods:
- Retrospective review of 27 patients with recurrent/persistent LBP after lumbar fusion.
- Provocation lumbar diskogram (PLD) performed on 31 fused levels.
- Assessment of PLD response (lidocaine, pain concordance), imaging findings (contrast leakage, CT), and fusion integrity.
- Evaluation of outcomes following redo-fusion surgery in 13 patients.
Main Results:
- Concordant pain identified in 65% of single-level fusions and at one fused level in two-level fusions.
- Adjacent-level pain identified in 30% of patients.
- Lidocaine injection provided pain relief in painful fused levels.
- Redo-fusion led to significant improvement in 9 of 13 patients.
Conclusions:
- Diskogenic pain at fused or adjacent levels is a potential cause of recurrent LBP after technically successful lumbar fusion.
- Lidocaine-assisted PLD is a valuable tool for diagnosing these pain sources.
- Revision surgery can be effective for selected patients identified by PLD.
Related Concept Videos
01:29Herniated Intervertebral Disc l: Introduction
Intervertebral disc herniation refers to the displacement of the nucleus pulposus (the gel-like inner core of the disc) through a tear or weakened area in the annulus fibrosus (the outer fibrous ring). The displaced disc material extends beyond the normal boundaries of the disc space and may compress or irritate nearby spinal nerve roots or, less commonly, the spinal cord.Etiology and Risk FactorsHerniation commonly results from degeneration, in which aging reduces disc hydration and...
01:23Degenerative Disc Disease ll: Pathophysiology
The symptoms of degenerative disc disease arise from a combination of mechanical compression, vascular compromise, and biochemical inflammation, which together disrupt nerve function and produce pain.Mechanical CompressionDisc degeneration reduces height and elasticity, predisposing to herniation of the nucleus pulposus, a major cause of radicular pain. Herniations may be protrusion (bulging with intact annulus), extrusion (nucleus extends beyond disc but remains connected), or sequestration...
01:27Degenerative Disc Disease I: Introduction
Degenerative disc disease is a chronic condition in which intervertebral discs gradually lose structure and function. It is not infectious or autoimmune; rather, it results from age-related biochemical and mechanical changes, influenced by genetic, metabolic, and environmental factors.Structure and Function of DiscsThe spine contains 23 intervertebral discs that absorb load, distribute forces, maintain spacing, and allow flexibility. Each disc consists of a nucleus pulposus, a gel-like core...