ABSTRACT
Objective To analyse the symptoms in discogenic low back pain and their neurological anatomic mechanism,and to explore the theoretical basis of symptomatic diagnosis of discogenic low back pain.Methods From January 2010 to December 2013, 289 patients were primarily diagnosed as discogenic discogenic low pain in our department, of which 164 patients showing only single abnormal segment on MRI were enrolled, including 99 male and 65 female patients, averaging 42 years old.All patients underwent discography.All the symptoms conform to the neurological anatomic mechanism of lumbar disc, i.e.extensive low back pain, posterior ilium pain, lateral thigh pain, groin pain, low abdomen pain, were recorded postoperatively.Then the occurrence rate of each symptom with positive discography was calculated.The positive rate (equal to sensitivity of the symptom to the diagnosis of discogenic low pain) of discography when each symptom occurred and the negative rate (equal to specificity of the diagnosis of the symptom to the discogenic low pain) of discography when each symptom did not occur were calculated respectively.Results The discographies of 129 (78.7％) in 164 patients were positive, of these patients 95 (73.6％) had the symptom of extensive low back pain, 99 (76.7％) had posterior ilium pain, 58 (45.0％) had lateral thigh pain, 29 (22.3％) had groin pain, and 24(18.6％) had low abdomen pain.The positive rate of discography in those with the symptom of extensive low back pain, posterior ilium pain, lateral thigh pain, groin pain and low abdomen pain was 89.6％, 90.8％, 90.6％, 90.6％ and 92.3％ respectively, i.e.the diagnostic sensitivity to the discogenic low back pain of the symptom of extensive low back pain, posterior ilium pain, lateral thigh pain, groin pain and low abdomen pain was 89.6％, 90.8％, 90.6％, 90.6％ and 92.3％ respectively.Conclusion The occurrence of the above-mentioned symptoms in the discogenic low back pain is conform to the neurological anatomic mechanism of efferent nerve of lumbar disc.These symptoms have great diagnostic significance for discogenic low back pain.
ABSTRACT
ObjectiveTo demonstrate the project scope of the afferent nerves of the lumbar intervertebral disc,on which basis to explore the mechanism of the symptoms of discgenic low back pain.MethodsThirty Wistar rats were divided randomly into three groups of 10 rats each:the L4-5,L5-6,and L6 S1 group.Each group was further divided randomly into two subgroups,the experimental group and the control group,5 rats for each group.Intervertebral disc was exposed through the posterior approach under peritoneal cavity anesthesia,after the nerve roots were pull away,2 μl of 30％ cholera toxin-horseradish peroxidase (CT-HRP) was injected into the inner layer of the intervertebral disc in the experimental group,while 2 μl of 0.9％ Nacl was used in the control group.Forty-eight hours after the surgery,all rats were perfused and bilateral dorsal root ganglions(DRGs) of T10-L3 were resected and fixxied.Each DRG was sectioned at 30 μm thickness and processed by DAB method.The sections of DRGs were coverslipped and observed by optical microscopy for the neurons or axons labelled by CT-HRP.It was judged as positive that brownish-black particles were in the neurons or axons.ResultsNot in a single dorsal root ganglions,but in a scope of dorsal root ganglions axons labled by CT-HRP could be seen in the rats in the experimental groups.No CT-HRP labled neurons or axons were seen in dorsal root ganglions in the contral groups.ConclusionAfferent nerves of the lumbar intervertebral disc project to a scope of dorsal root ganglions,which is the anatomic basis of the mechanism of the symptoms of discgenic low back pain.