Abstract
Objective To explore the relationship between discography pressure and outcome of an-terior lumbar interbody fusion (ALIF) for discogenic low back pain. Methods From April 2004 to June 2006, 65 patients with chronic low back pain were identified as diseogenic origin by pressure controlled discography, 22 cases of which received ALIF after failed conservative treatment for at least 6 months. The surgically treated patients aged 43.6 on the average (range, 25-67). The treated discs located: 8 in L4-5, 12 in L5S1, 2 in both L4-5 and L5S1. 22 cases received ALIF in 24 levels via retroperitoneal approach. The pressure as soon as accordant initially induced pain was recorded during discography. Low pressure (pressure ≤ 300kPa) in 10 cases and high pressure (pressure 300-500 kPa) in 12 cases. At 3 days postoperative, the patients were allowed to leave bed with a brace, and the brace should be used for 3 months. Results All the cases were followed up for average 18 months (range, 6-26 months). At the end of follow-up all the patients recov-ered normal social life and work without any symptoms. Disc height increased from 9.5 mm preoperatively to 13.5 mm postoperatively. Surgery time averaged 90 rain (70-120 rain); blood loss averaged 220 ml (100-400ml). Low pressure group and high pressure group showed no significant different in VAS, ODI, disc height,surgery time and blood loss preoperatively. At 6 months follow up, VAS and ODI improve rates of low pres-sure group account for 82.4% and 90.1% respectively; and those of high pressure group account for 71.7%and 80.6% respectively. No ileus, retrograde ejaculation nor artificial disc translation was noticed during fol-low-up. Conclusion Pressure-controlled discography can increase the diagnostic accuracy of discogenic lowback pain, and a positive discography on low pressure indicates better surgical outcome. Key words: Lumbar vertebrae; Intervertebral disk; Pain; Pressure
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