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Discogenic pain persisting despite solid posterior fusion.

C R Weatherley, C F Prickett, J P O'Brien

    The Journal of Bone and Joint Surgery. British Volume
    |January 1, 1986
    PubMed
    Summary
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    Persistent back pain after posterior fusion may not be psychogenic. Lateral discography revealed the fused disc as the pain source in five patients, treated successfully with anterior interbody fusion. This highlights a treatable cause of failed back surgery.

    Area of Science:

    • Spine surgery
    • Pain management
    • Orthopedics

    Background:

    • Persistent back pain following posterior spinal fusion is often misattributed to psychogenic causes.
    • Patients with intact posterior fusions can experience chronic disabling pain.
    • The interbody disc within the fused segment is a potential, yet often overlooked, pain generator.

    Purpose of the Study:

    • To investigate the diagnostic utility of lateral discography in identifying the source of persistent back pain in patients with prior posterior fusion.
    • To evaluate the efficacy of anterior interbody fusion in treating chronic back pain originating from the fused disc segment.
    • To challenge the prevailing notion that such pain is solely psychogenic and propose an alternative etiology.

    Main Methods:

    • Case series of five chronically disabled patients with confirmed posterior and/or lateral fusion and persistent back pain.

    Related Experiment Videos

  • Diagnostic lateral discography was performed to identify the pain source within the fused spinal segment.
  • Treatment involved anterior interbody fusion for patients with positive discographic findings.

    • Main Results:

    • Lateral discography successfully identified the interbody disc within the fused segment as the source of pain in all five patients.
    • All five patients experienced significant pain relief and functional improvement following anterior interbody fusion.
    • This demonstrates a clear correlation between discogenic pain within the fused segment and treatment success.

    Conclusions:

    • Interbody disc pain within a previously fused segment is a significant and treatable cause of persistent back pain after posterior spinal fusion.
    • Lateral discography is a valuable diagnostic tool for identifying this specific pain source.
    • Anterior interbody fusion offers an effective treatment option for selected patients with failed back surgery syndrome due to fused segment discopathy.