Disc Excision and Posterior Lumbar Interbody Fusion for Internal Disc Derangement / 대한척추외과학회지

STUDY DESIGN: This study reviewed prospectively 15 patients with chronic persistent low back pain who were treated with disc excision and posterior lumbar interbody fusion(PLIF). Outcomes of treatment were evaluated by a follow-up interview and x-ray studies. OBJECTIVES: To evaluate the efficacy of surgical treatment of patients with chronic persistent low back pain resulting from internal disc derangement (IDD) that does not respond to conservative treatments. SUMMARY OF LITERATURE REVIEW: Chronic persistent low back pain resisting to all known modalities of conservative treatments represents a difficult problem. The efficacy of any specific treatment methods for this group of patients is controversial. MATERIALS AND METHODS: Between 1994 and 2000, 15 patients were treated with disc excision and PLIF at Keimyung University Hospital from 1994 to 2000. The clinical outcomes were evaluated by postoperative follow-up interviews, and the fusion results were evaluated by x-ray studies. RESULTS: All patients responded properly to the follow-up evaluation. 66.6% of the patients had satisfactory results(13.3% excellent, 53.3% good, 26.7% fair, 6.7% poor), and a successful fusion was obtained in all of the patients. CONCLUSION: These results suggest that disc excision and PLIF for IDD patients is effective modality in treatment of IDD.

Comparison of Magnetic Resonance Imaging and Discography in the Diagnosis of Internal Disc Derangement / 대한정형외과학회잡지

PURPOSE: To compare the effectiveness of Magnetic Resonance Imaging and discography in the diagnosis of internal disc derangement (IDD) . MATERIALS AND METHODS: This study was confined to 90 discs of 30 patients diagnosed as IDD by MRI & disco-CT. We compared the pain nature of discogram, degree of annular tear in the disco-CT and degree of disc degeneration in MRI. The presence of HIZ (High Intensity Zone) in MRI was also compared with the pain of discogram. RESULTS: Those discs with more severe annular tears in the disco-CT showed more definite pain pattern in the discogram. More degeneration in the MRI was also correlated with more anatomical deterioration in disco-CT. Of the 27 discs with normal MRI, 6 (22%) showed severe pain provocation in discography. Of the 63 discs with degeneration in MRI, 14 (22%) showed no pain provocation in discography. Of all discs, HIZ was present in 16% (15/90) . When HIZ was present in a disc of a symptomatic patient, the possibility of it being a painful disc was 93%. CONCLUSION: In the diagnosis of IDD, MRI was helpful is seeing the degree of disc degeneration to rule out disc herniation or spinal stenosis. But the discogram is considered the only way for definite diagnosis of painful discs.