Etiology of Chronic Low Back Pain in Patients Having Undergone Lumbar Fusion
- 1 May 2011
- journal article
- Published by Oxford University Press (OUP) in Pain Medicine
- Vol. 12 (5), 732-739
- https://doi.org/10.1111/j.1526-4637.2011.01098.x
Abstract
To estimate the prevalence of lumbar internal disc disruption, zygapohyseal joint pain, sacroiliac joint pain, and soft tissue irritation by fusion hardware in post-fusion low back pain patients compared with non-fused patients utilizing diagnostic spinal procedures. Retrospective chart review. University spine center. Patients presenting to a community-based, multidisciplinary, academic spine center (65.9% female, mean age 54.4 years, median pain duration 12 months). Charts of consecutive low back pain cases completing diagnostic spinal procedures including provocation discography and zygapohyseal joint, sacroiliac joint, and fusion hardware blockade were retrospectively reviewed. Based on the results of discography and/or diagnostic blockades, subjects were classified with internal disc disruption, zygapohyseal joint pain, sacroiliac joint pain, or fusion hardware related pain. The diagnoses of 28 fusion cases identified from 170 low back pain patients undergoing diagnostic procedures included 12 with sacroiliac joint pain, seven with internal disc disruption, five with zygapohyseal joint pain, and four due to soft tissue irritation from fusion hardware. No significant differences were noted in zygapohyseal joint mediated pain with and without fusion history. Mean ages of patients were similar with and without fusion history for cases diagnosed as internal disc disruption. In patients' recalcitrant to non-interventional care, the sacroiliac joint is the most likely source of low back pain after lumbar fusion followed by internal disc disruption, zygapohyseal joint pain, and soft tissue irritation due to fusion hardware. Sacroiliac joint pain is more common after fusion, while internal disc disruption is more common in non-fusion patients.Keywords
This publication has 45 references indexed in Scilit:
- Biomechanical comparison of single-level posterior versus transforaminal lumbar interbody fusions with bilateral pedicle screw fixation: segmental stability and the effects on adjacent motion segmentsJournal of Neurosurgery: Spine, 2010
- A prospective randomised study on the long-term effect of lumbar fusion on adjacent disc degenerationEuropean Spine Journal, 2009
- A Gold Standard Evaluation of the “Discogenic Pain” Diagnosis as Determined by Provocative DiscographySpine, 2006
- Sacroiliac joint pain after lumbar fusion. A study with anesthetic blocksEuropean Spine Journal, 2005
- Spinal-Fusion Surgery — The Case for RestraintThe New England Journal of Medicine, 2004
- Computed Tomographic Findings in Patients With Persistent Sacroiliac Pain after Posterior Iliac Graft HarvestingSpine, 2000
- The Prevalence and Clinical Features of Internal Disc Disruption in Patients With Chronic Low Back PainSpine, 1995
- Variations in the Nutrition of the Canine Intervertebral Disc Induced by MotionSpine, 1983
- Nutritional Changes in the Canine Intervertebral Disc after Spinal FusionClinical Orthopaedics and Related Research, 1982
- Causes of Failure of Surgery on the Lumbar SpineClinical Orthopaedics and Related Research, 1981