Is the history of a surgical discectomy related to the source of chronic low back pain?

Michael J. Depalma, Jessica McKinney Ketchum, Thomas R. Saullo, Ben L. Laplante

Research output: Contribution to journalReview article

27 Citations (Scopus)

Abstract

Background: Recurrent or persistent low back pain (LBP) after surgical discectomy (SD) for intervertebral disc herniation has been well documented. The source of low back pain in these patients has not been examined. Objective: To compare the distribution of the source of chronic LBP between patients with and without a history of SD. Study Design: Retrospective chart review. Setting: Academic spine center. Patients: Charts from 358 consecutive patients were reviewed. Charts noting the absence/presence of SD in patients who subsequently underwent diagnostic injections to determine the source of chronic LBP were included resulting in 158 unique cases for analysis. Methods: Patients underwent either dual diagnostic facet joint blocks, intra-articular diagnostic sacroiliac joint injections, provocation lumbar discography, or anesthetic injection into putatively painful interspinous ligaments/opposing spinous processes/posterior fusion hardware. If the initial diagnostic procedure was negative, the next most likely structure in the diagnostic algorithm was interrogated. Subsequent diagnostic procedures were not performed after the source of chronic LBP was identified. Outcome: The source of chronic LBP was diagnosed as discogenic pain (DP), facet joint pain (FJP), sacroiliac joint pain (SIJP), or other sources of chronic LBP. Results: Based on a Fisher's exact test, there was marginal evidence the distribution of the source of chronic LBP differed for those with and without a history of SD (P = 0.080). Posthoc comparisons suggested that patients with a history of SD have a higher probability of DP compared to those without a history of SD (82% versus 41%; P = 0.011). Differences in the probability of FJP, SIJP, or other sources between the SD history groups were not significant. Limitations: Small sample size, restrospective design, and possible false-positive results. Conclusions: This is the first published investigation of the tissue source of chronic LBP after SD. It appears that DP is the most common reason for chronic LBP after SD. If more rigorous study confirms our findings, future biologic treatments may hold value in repairing symptomatic annular fissures after SD.

Original languageEnglish (US)
Pages (from-to)53-58
Number of pages6
JournalPain Physician
Volume15
Issue number1
StatePublished - Jan 1 2012

Fingerprint

Diskectomy
Low Back Pain
History
Arthralgia
Zygapophyseal Joint
Sacroiliac Joint
Pain
Injections
Intervertebral Disc
Ligaments
Sample Size
Anesthetics
Spine
Retrospective Studies
Joints

Keywords

  • Chornic low back pain
  • Diagnostic injections
  • Discogenic pain
  • Facet joint
  • Low back pain
  • Lumbar provocation discography
  • Medial branch block
  • Sacroiliac joint
  • Surgical discectomy

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Depalma, M. J., Ketchum, J. M., Saullo, T. R., & Laplante, B. L. (2012). Is the history of a surgical discectomy related to the source of chronic low back pain? Pain Physician, 15(1), 53-58.

Is the history of a surgical discectomy related to the source of chronic low back pain? / Depalma, Michael J.; Ketchum, Jessica McKinney; Saullo, Thomas R.; Laplante, Ben L.

In: Pain Physician, Vol. 15, No. 1, 01.01.2012, p. 53-58.

Research output: Contribution to journalReview article

Depalma, MJ, Ketchum, JM, Saullo, TR & Laplante, BL 2012, 'Is the history of a surgical discectomy related to the source of chronic low back pain?', Pain Physician, vol. 15, no. 1, pp. 53-58.
Depalma MJ, Ketchum JM, Saullo TR, Laplante BL. Is the history of a surgical discectomy related to the source of chronic low back pain? Pain Physician. 2012 Jan 1;15(1):53-58.
Depalma, Michael J. ; Ketchum, Jessica McKinney ; Saullo, Thomas R. ; Laplante, Ben L. / Is the history of a surgical discectomy related to the source of chronic low back pain?. In: Pain Physician. 2012 ; Vol. 15, No. 1. pp. 53-58.
@article{16f068407a894e848ed55c69499b407d,
title = "Is the history of a surgical discectomy related to the source of chronic low back pain?",
abstract = "Background: Recurrent or persistent low back pain (LBP) after surgical discectomy (SD) for intervertebral disc herniation has been well documented. The source of low back pain in these patients has not been examined. Objective: To compare the distribution of the source of chronic LBP between patients with and without a history of SD. Study Design: Retrospective chart review. Setting: Academic spine center. Patients: Charts from 358 consecutive patients were reviewed. Charts noting the absence/presence of SD in patients who subsequently underwent diagnostic injections to determine the source of chronic LBP were included resulting in 158 unique cases for analysis. Methods: Patients underwent either dual diagnostic facet joint blocks, intra-articular diagnostic sacroiliac joint injections, provocation lumbar discography, or anesthetic injection into putatively painful interspinous ligaments/opposing spinous processes/posterior fusion hardware. If the initial diagnostic procedure was negative, the next most likely structure in the diagnostic algorithm was interrogated. Subsequent diagnostic procedures were not performed after the source of chronic LBP was identified. Outcome: The source of chronic LBP was diagnosed as discogenic pain (DP), facet joint pain (FJP), sacroiliac joint pain (SIJP), or other sources of chronic LBP. Results: Based on a Fisher's exact test, there was marginal evidence the distribution of the source of chronic LBP differed for those with and without a history of SD (P = 0.080). Posthoc comparisons suggested that patients with a history of SD have a higher probability of DP compared to those without a history of SD (82{\%} versus 41{\%}; P = 0.011). Differences in the probability of FJP, SIJP, or other sources between the SD history groups were not significant. Limitations: Small sample size, restrospective design, and possible false-positive results. Conclusions: This is the first published investigation of the tissue source of chronic LBP after SD. It appears that DP is the most common reason for chronic LBP after SD. If more rigorous study confirms our findings, future biologic treatments may hold value in repairing symptomatic annular fissures after SD.",
keywords = "Chornic low back pain, Diagnostic injections, Discogenic pain, Facet joint, Low back pain, Lumbar provocation discography, Medial branch block, Sacroiliac joint, Surgical discectomy",
author = "Depalma, {Michael J.} and Ketchum, {Jessica McKinney} and Saullo, {Thomas R.} and Laplante, {Ben L.}",
year = "2012",
month = "1",
day = "1",
language = "English (US)",
volume = "15",
pages = "53--58",
journal = "Pain Physician",
issn = "1533-3159",
publisher = "Association of Pain Management Anesthesiologists",
number = "1",

}

TY - JOUR

T1 - Is the history of a surgical discectomy related to the source of chronic low back pain?

AU - Depalma, Michael J.

AU - Ketchum, Jessica McKinney

AU - Saullo, Thomas R.

AU - Laplante, Ben L.

PY - 2012/1/1

Y1 - 2012/1/1

N2 - Background: Recurrent or persistent low back pain (LBP) after surgical discectomy (SD) for intervertebral disc herniation has been well documented. The source of low back pain in these patients has not been examined. Objective: To compare the distribution of the source of chronic LBP between patients with and without a history of SD. Study Design: Retrospective chart review. Setting: Academic spine center. Patients: Charts from 358 consecutive patients were reviewed. Charts noting the absence/presence of SD in patients who subsequently underwent diagnostic injections to determine the source of chronic LBP were included resulting in 158 unique cases for analysis. Methods: Patients underwent either dual diagnostic facet joint blocks, intra-articular diagnostic sacroiliac joint injections, provocation lumbar discography, or anesthetic injection into putatively painful interspinous ligaments/opposing spinous processes/posterior fusion hardware. If the initial diagnostic procedure was negative, the next most likely structure in the diagnostic algorithm was interrogated. Subsequent diagnostic procedures were not performed after the source of chronic LBP was identified. Outcome: The source of chronic LBP was diagnosed as discogenic pain (DP), facet joint pain (FJP), sacroiliac joint pain (SIJP), or other sources of chronic LBP. Results: Based on a Fisher's exact test, there was marginal evidence the distribution of the source of chronic LBP differed for those with and without a history of SD (P = 0.080). Posthoc comparisons suggested that patients with a history of SD have a higher probability of DP compared to those without a history of SD (82% versus 41%; P = 0.011). Differences in the probability of FJP, SIJP, or other sources between the SD history groups were not significant. Limitations: Small sample size, restrospective design, and possible false-positive results. Conclusions: This is the first published investigation of the tissue source of chronic LBP after SD. It appears that DP is the most common reason for chronic LBP after SD. If more rigorous study confirms our findings, future biologic treatments may hold value in repairing symptomatic annular fissures after SD.

AB - Background: Recurrent or persistent low back pain (LBP) after surgical discectomy (SD) for intervertebral disc herniation has been well documented. The source of low back pain in these patients has not been examined. Objective: To compare the distribution of the source of chronic LBP between patients with and without a history of SD. Study Design: Retrospective chart review. Setting: Academic spine center. Patients: Charts from 358 consecutive patients were reviewed. Charts noting the absence/presence of SD in patients who subsequently underwent diagnostic injections to determine the source of chronic LBP were included resulting in 158 unique cases for analysis. Methods: Patients underwent either dual diagnostic facet joint blocks, intra-articular diagnostic sacroiliac joint injections, provocation lumbar discography, or anesthetic injection into putatively painful interspinous ligaments/opposing spinous processes/posterior fusion hardware. If the initial diagnostic procedure was negative, the next most likely structure in the diagnostic algorithm was interrogated. Subsequent diagnostic procedures were not performed after the source of chronic LBP was identified. Outcome: The source of chronic LBP was diagnosed as discogenic pain (DP), facet joint pain (FJP), sacroiliac joint pain (SIJP), or other sources of chronic LBP. Results: Based on a Fisher's exact test, there was marginal evidence the distribution of the source of chronic LBP differed for those with and without a history of SD (P = 0.080). Posthoc comparisons suggested that patients with a history of SD have a higher probability of DP compared to those without a history of SD (82% versus 41%; P = 0.011). Differences in the probability of FJP, SIJP, or other sources between the SD history groups were not significant. Limitations: Small sample size, restrospective design, and possible false-positive results. Conclusions: This is the first published investigation of the tissue source of chronic LBP after SD. It appears that DP is the most common reason for chronic LBP after SD. If more rigorous study confirms our findings, future biologic treatments may hold value in repairing symptomatic annular fissures after SD.

KW - Chornic low back pain

KW - Diagnostic injections

KW - Discogenic pain

KW - Facet joint

KW - Low back pain

KW - Lumbar provocation discography

KW - Medial branch block

KW - Sacroiliac joint

KW - Surgical discectomy

UR - http://www.scopus.com/inward/record.url?scp=84856450023&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84856450023&partnerID=8YFLogxK

M3 - Review article

C2 - 22270748

AN - SCOPUS:84856450023

VL - 15

SP - 53

EP - 58

JO - Pain Physician

JF - Pain Physician

SN - 1533-3159

IS - 1

ER -