Painful internal disc derangements of the lumbosacral spine: discographic diagnosis and treatment by posterior lumbar interbody fusion.

Results of surgical or non-surgical treatment of patients with chronic persistent low back pain, but without clearly demonstrable diagnosis of disc herniation, spinal stenosis, or spinal instability, range between 50% to 80% of success rates in the literature. Between 1984 and 1988, the authors reviewed 25 consecutive cases of internal derangements of the lumbar disc treated by subtotal disc excision and interbody fusion. All patients had chronic, persistent, or frequently recurring low back pain resistant to active nonoperative treatments for a minimum of 3 months (mean: 16); no evidence of disc herniation, stenosis, or instability; no previous operation; single level of the pathologic condition in L-S spine; and diagnosis made by clinical information, CT, MRI, and/or discography. Ages ranged from 25 to 51 (mean: 38 to 40). Average follow up was 2 years (range: 13 to 57 months). In addition, 20 patients (32 discographics) who had available information of discography, MRI, and CT scan of the L-S spine, were reviewed for the relationship between disc morphology, pressure, volume, and pain response during discography. Overall clinical results for the 25 patients were: 58% excellent (15 of 26), 31% good (8 of 26), and 11% fair (3 of 26). No patients were in the "poor" category. The successful fusion rate was 95%.