Chinese Journal of Tissue Engineering Research ›› 2011, Vol. 15 ›› Issue (22): 4171-4175.doi: 10.3969/j.issn.1673-8225.2011.22.043

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Can the degeneration adjacent to herniated disc in patients with lumbar disc herniation cause low pack pain?

Wang Gang1, Liu Shang-li2, Chen Zhi-wei1, Guan Hong-gang1, Han Dun-fu2, Shi Yan-zhang3   

  1. 1Department of Orthopedic Surgery, Foshan Hospital of Traditional Chinese Medicine, Foshan  528000, Guangdong Province, China
    2Department of Orthopedic Surgery, the Second Affiliated Hospital of Sun Yat-sen University, Guangzhou  510120, Guangdong Province, China
    3Department of Orthopedic Surgery, the Central Hospital of Shantou City, Shantou  515031, Guangdong Province, China
  • Received:2011-02-25 Revised:2011-04-03 Online:2011-05-28 Published:2011-05-28
  • Contact: Liu Shang-li, Doctor, Professor, Department of Orthopedic Surgery, the Second Affiliated Hospital of Sun Yat-sen University, Guangzhou 510120, Guangdong Province, China gzxy168@126.com
  • About author:Wang Gang☆, Doctor, Attending physician, Department of Orthopedic Surgery, Foshan Hospital of Traditional Chinese Medicine, Foshan 528000, Guangdong Province, China wanggang2003@yeah.net

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Abstract:

BACKGROUND: It is often difficult to determine the cause of low back pain (LBP) in the patients with lumbar disc herniation. The herniated disc has long been thought to be an important cause of the patient’s complaint about LBP and sciatica. Whether the adjacent degenerative disc results in LBP needs further confirmations. 
OBJECTIVE: This study sought to determine whether the degenerative disc adjacent to the herniated disc in patients with LBP and radicular pain can result in discogenic LBP, as assessed by provocative discography, and to report the outcomes of the residual LBP when adjacent symptomatic disc were treated with methylene blue after microendoscopic discectomy.
METHODS: Twenty lumbar disc herniation patients complaint about LBP and radicular pain underwent provocative discography. There was one degenerative herniated disc with one or more adjacent degenerative discs in their MRI. Provocative discography was performed on all degenerative discs and at least one normal disc for control. The severity of LBP and leg pain of all patients was assessed using visual analog scale before discography. All patients underwent microendoscopic discectomy at herniated level, and intradiscal injection of methylene blue was given at painful adjacent level in five patients after microendoscopic discectomy.
RESULTS AND CONCLUSION: Discographies were performed on 64 discs of 20 patients, from L2-3 to L5-S1. There were 11 discs satisfying the positive response criteria, including 6 in degenerative segment adjacent to the herniated disc and 5 in the herniated disc that induced corresponding radiculopathy. The leg pains were evidently improved in all patients, while LBP was partially improved after microendoscopic discectomy. Six patients with symptomatic adjacent degenerative disc still had evident LBP, influencing their daily living. Five of them received intradiscal injection of methylene blue treatment and the LBP was relived. One patient refusing to the treatment still complained the LBP. Results evidenced that accompanying LBP for many LDH patients may come from the degenerative levels adjacent to the herniated disc.

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