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The spine
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
A recent study has compared rehabilitation with spinal fusion for discogenic pain. Both groups reported reductions in disability, with the authors strongly recommending a course of rehabilitation before surgical intervention. For those who fail to improve with conservative measures, provocative lumbar discography (see Figure33.1) may help to identify the source of pain, and surgery in the form of a lumbar spinal fusion (Figure33.3) or lumbar disc replacement (Figure33.4) may be considered.
Percutaneous spinal interventions and pain management
Published in Michael Y. Wang, Andrea L. Strayer, Odette A. Harris, Cathy M. Rosenberg, Praveen V. Mummaneni, Handbook of Neurosurgery, Neurology, and Spinal Medicine for Nurses and Advanced Practice Health Professionals, 2017
Due to the multiplicity of etiologies involved in low back and neck pain, the definitive diagnosis of true discogenic pain can be difficult. Both discography and magnetic resonance imaging (MRI) are used for this purpose, but proper diagnostic testing remains controversial with literature showing both poor positive and negative predictive values (PPV/NPV) from MRI and discography. Among the most contentious aspects of discography’s ability to diagnose discogenic pain is the fact that severely damaged discs do not always cause pain, and minimally damaged discs may cause severe pain. Moreover, the test has been implicated in potentially accelerating disc degeneration (Figure 60.1).
History-taking and examination of the patient with chronic pain
Published in Harald Breivik, William I Campbell, Michael K Nicholas, Clinical Pain Management, 2008
Paul R Nandi, Toby Newton-John
It is suggested that discogenic pain is significantly correlated with pain centralization on repetitive movement testing, lumbar facet joint pain with absence of provocation when rising from sitting, and sacroiliac pain with specific mechanical stressing.16 However, high degrees of disability and distress may be associated with reduced specificity of provocative tests of spinal pain and complicate their interpretation (see below under Over-reaction and related issues).17
Immunobiology of periprosthetic inflammation and pain following ultra-high-molecular-weight-polyethylene wear debris in the lumbar spine
Published in Expert Review of Clinical Immunology, 2018
John H. Werner, John H. Rosenberg, Kristen L. Keeley, Devendra K. Agrawal
Intervertebral disc pain is believed to be the product of a messenger cascade that ultimately results in blood vessels and sensory fibers invading the disc [71–73]. Understanding the mechanism of pain associated with degenerative disc disease (DDD) can help provide insight into the mechanism of pain associated with total disc replacement. Several mechanisms resulting in discogenic pain have been investigated. Recent studies suggest that Th17 cells largely contribute to discogenic pain associated with disc herniation and chronic back pain [74,75]. Cheng et al [74] demonstrated in an in vivo study that Th17 levels and interleukin-17 (IL-17) levels in the peripheral blood were strongly associated with ruptured lumbar discs and increased levels of pain compared to herniated lumbar discs. Increased IL-17 production could lead to increased PGE2 secretion resulting in increased pain [74]. Studies by Luchting et al [75] further support the importance of Th17 involvement in the pathogenesis of lumbar pain. Investigations into the role of Th17 cells and their mediators may provide useful insight into the pathogenesis of discogenic pain, and wear-debris induced osteolysis. Currently, the most supported mechanism outlining the pathogenesis of discogenic pain involves angiogenesis and neurogenesis.
Cervical myelopathy causing numbness and paresthesias in lower extremities: A case report identifying the cause of a false positive Sharp–Purser test
Published in Physiotherapy Theory and Practice, 2019
A common practice among physical therapists is to create a differential diagnoses list prior to the examination of the patient. After reviewing the patient’s age, the Oswestry disability index (ODI), and the colored areas on the body chart there were a few pathologies that could explain her symptomology. Bilateral symptoms in the legs could be explained by lumbar stenosis, cervical myelopathy or cauda equina syndrome (Crowell and Gill, 2009; Sizer, Brismée, and Cook, 2007). Somatic referral/discogenic pain seemed unlikely as this typically causes radicular paresthesia into one of the lower extremities. Her score on the ODI was 14% with sitting being the highest ranked item.
A multivariate prognostic model for pain and activity limitation in people undergoing lumbar discectomy
Published in British Journal of Neurosurgery, 2020
Jon J. Ford, Omar Kaddour, Patrick Page, Matthew C. Richards, Joan M. McMeeken, Andrew J. Hahne
Given the complexity and multi-factorial nature of low back disorders,28 composite items may be more likely to be clinically meaningful and prognostic. We, therefore, derived composite items for clinical radiculopathy ± nerve root compression ± distal symptoms most severe (as each of these features plausibly increases the likelihood of symptomatic DHR that would be responsive to surgery) as well as clinically diagnosed discogenic pain29without clinical radiculopathy (as such cases would be plausibly not suitable for discectomy).