Artikel
Automated pressure-controlled discography in patients undergoing anterior lumbar interbody fusion for discogenic back pain
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Veröffentlicht: | 8. Juni 2016 |
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Gliederung
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Objective: To compare the clinical outcomes of patients undergoing anterior lumbar interbody fusion (ALIF), with or without automated pressure-controlled discography (APCD) prior to the procedure.
Method: Consecutive patients (n=36) who underwent ALIF for lumbar discogenic back pain between 2008 and 2013 and were followed for more than six months were enrolled in this study. APCD was performed to identify discogenic back pain. Preoperative x-rays, CT images, and MRI images were obtained. The intervertebral disc height, type of Modic change, and fusion rate were determined. Additionally, the presence or absence of high intensity zone and vacuum disc were checked preoperatively. Clinical evaluation was performed by visual analog scale (VAS; 0=no pain, 10=worst pain imaginable), Oswestry Disability Index (ODI), and SF-36 before surgery and every six months postoperatively.
Results: The average patient age was 53.3 years (range, 31-73 years). There were 16 males and 20 females enrolled. Seventeen patients (the APCD-ALIF group) underwent ALIF after APCD, and 19 patients underwent ALIF without APCD. The APCD-ALIF group had significantly improved clinical outcomes compared to the control group (VAS score 1.8 ± 1.6 vs. 3.3 ± 2.4; p= 0.039 : ODI score 6.7 ± 6.3 vs. 12.1 ± 6.8; p= 0.019). The surgical improvement rate (SIR) was significantly associated with ODI score (p=0.005). However, the intervertebral disc height, type of Modic change, and presence of high intensity zone and vacuum disc were not correlated with clinical outcome.
Conclusions: The results of this study confirm that APCD aids surgical outcomes of ALIF in patients with suspected lumbar discogenic pain. We recommend performing APCD before ALIF to confirm lumbar discogenic pain.