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Radiating pain to the lower extremities caused by lumbar disk rupture without spinal nerve root involvement
P C Milette1, S Fontaine, L Lepanto
1Department of Radiology, Hôpital Saint-Luc, Montreal, Quebec, Canada.
AJNR. American Journal of Neuroradiology
|September 1, 1995
Summary
Local anesthetic injection during lumbar diskography helped identify pain origin. This confirmed that some low back pain with leg radiation stems from the intervertebral disc itself, not nerve compression.
Area of Science:
- Spine surgery
- Pain management
- Diagnostic imaging
Background:
- Low back pain with radiating symptoms is a common clinical problem.
- The precise origin of pain in some patients remains challenging to diagnose.
- Lumbar diskography is an invasive diagnostic procedure used to evaluate discogenic pain.
Purpose of the Study:
- To determine if localized anesthetic injection into the intervertebral disc can identify the source of pain.
- To differentiate between discogenic pain and nerve root compression in patients undergoing lumbar diskography.
Main Methods:
- 235 patients underwent lumbar diskography using a direct central posterior approach.
- In 17 patients with provoked pain, 1% lidocaine was injected into the affected disc.
- Pain reduction and radiographic findings were assessed post-injection.
Main Results:
- 13 patients experienced significant reduction in low back pain (75-100%) after lidocaine injection.
- 16 patients reported similar reduction in radiating leg pain within 60 seconds.
- Radiographs revealed radial annulus tears in 16 of 17 tested discs.
Conclusions:
- Intradiscal lidocaine injection can effectively localize pain originating from the intervertebral disc.
- Radiating leg pain in these patients appears to be referred pain, not directly caused by nerve root irritation.
- These findings suggest discogenic pain is a significant contributor to low back pain with radicular symptoms.