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Related Experiment Video

Updated: Jun 7, 2026

Multilevel Oblique Lumbar Interbody Fusion in Degenerative Lumbar Disc Disease with Instability

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.

Interventional Neuroradiology : Journal of Peritherapeutic Neuroradiology, Surgical Procedures and Related Neurosciences

|October 28, 2010

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.

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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.