OUTCOME OF UNOPERATED DISCOGRAM-POSITIVE LOW-BACK-PAIN

Study Design. No previous discography study has addressed the nonopera tive outcome of low back pain. Objectives. This study was undertaken t o retrospectively analyze the outcome of patients with documented sing le-level discogenic pain who were considered candidates for surgery bu t did not receive it. Summary of Background Data. The natural history of ''discogenic'' low back pain is unknown, and its treatment is contr oversial. Although positive discography is viewed as a valid diagnosti c technique, the results of fusion surgery are often disappointing. Me thod, Twenty-five individuals (16 women, 9 men) underwent comprehensiv e evaluation (examination, radiography, objective disability determina tion). Study criteria included incapacitating low back pain, single-le vel + morphologic + provocative discogram, no surgery, and a minimum f ollow-up period of 3 years. Results, Average age of patients at discog raphy was 43 years and at study was 48 years; level of involvement in 10 patients was L4-L5 and in 15 patients was L5-S1. The mean follow-up period was 4.9 years (range, 3.3-7.0 years). The condition of 17 (68% ) patients improved, two (8%) stayed the same, and six (24%) worsened. Improved patients had a shorter history of low back pain (3.5 yr vs. 11.0 yr) and older age at onset (45 versus 33 yrs.) Psychiatric diseas e was present in 66.7% (4 of 6) patients whose conditions worsened. Ei ghty percent (12 of 15) of patients receiving workers' compensation im proved. There was no correlation between disc level, gender, smoking, and outcome. Conclusions. Discogenic low back pain improved in patient s without psychiatric disease, Older age at onset and shorter duration of low back pain were favorable indicators. These results are compara ble with or better than those reported for surgical treatment of this condition.