Isolated Lumbar Disc Disease Found and Treated

Isolated Lumbar Disc Disease Can be Determined by Non-Invasive Magnetic Resonance Spectroscopy (MRS) and Responds to Surgery. Non-Invasive Magnetic Resonance Spectroscopy scans for certain disc chemicals-  lactate (LA) and proteoglycan (PG), as quantifiable biomarkers for discogenic pain. It was found to have “total accuracy of 85%, sensitivity of 82%, and specificity of 88%. These increased to 93%, 91%, and 93%
respectively, in non-herniated discs” – when compared to provocative discography (PD).  Surgery to positive discs made it practical: :”when all MRS positive discs were treated, surgical success was 97% versus 57% when the treated level was MRS negative, or 54% when the non-treated adjacent level was MRS positive.”

Eur Spine J. 2019 Jan 4. doi: 10.1007/s00586-018-05873-3. [Epub ahead of print]
Magnetic resonance spectroscopy (MRS) can identify painful lumbar discs and may
facilitate improved clinical outcomes of lumbar surgeries for discogenic pain.
Gornet MG et al.
https://www.ncbi.nlm.nih.gov/pubmed/30610465

  • “Discogenic” CLBP (DLBP) diagnosis often results from a process of elimination to rule out other pathology, as well as MRI evidence of at least one degenerated disc as a potential etiology of pain.

Discogenic back pain is a condition that abhors flexion. A study which isolated discogenic back pain by discoblock and found flexion by bending forward, and by sitting was not well tolerated:

Tonosu, Juichi, et al.
Diagnosing discogenic low back pain associated with degenerative disc disease using a medical interview.
PloS one 11.11 (2016): e0166031.
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0166031

  • 42 degenerative disc disease; 30 controls
  • average age was 53.9 years in the DDD group and 71.1 years in the control group (not good but they felt other features were equal)
  • pain localized between the costal margin and the inferior gluteal folds
  • >/= grade 4 degeneration on sagittal T2-weighted MRI based on Pfirrmann’s grading system [21] considered disc degeneration
  • successful discoblock = less than 50% of pain left after “a 1-mL injection of 1% lidocaine into the disc” distinguished disogenic

raw data results:

disc_flex1

Hence discogenic back pains do not like flexion.

 

As for the first study,

  • pain >4/10 with pain into legs < 3/10
  • scans for certain disc chemicals-  lactate (LA) and proteoglycan (PG)

bad discs

  • “total accuracy of 85%, sensitivity of 82%, and specificity of 88%.
    These increased to 93%, 91%, and 93% respectively, in non-herniated discs”

Using these results to do surgery:

  • “when all MRS positive discs were treated, surgical success was 97% versus 57% when the treated level was MRS negative, or 54% when the non-treated adjacent level was MRS positive.

Comment – flexion intolerant back pain could be discogenic. Up to now, provocative discogram or successful discoblock might be needed for diagnosis. It looks like Non-Invasive Magnetic Resonance Spectroscopy scans might be suitable substitute.

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