Effect Of CT Discography And Zygapophysial Joint Block In Diagnosing And Treating Low Back Pain

Background and Objection: Low back pain is one of the most common reasons of disability and extremely complex syndrome in spinal disorders and a common performance of various diseases. Although the CT,MRI and other non-invasive technique has been popular, there are still many patients with low back pain can not have definite diagnosis, not to mention dffective treatment.Due to the degenerative segment of intervertebral disc, zygapophysial joint pain. The discogenic low back pain and zygapophysial joint pain have similar clinical manifestations,even overlaps. X-ray and other imaging examination have provide some helps,most of patients still meed to carry out some invasive checks to identify diagnosis and treatment's program such as CT discography and zygapophysial joint block. While the patients with multiple-segments disc lesions need to be identified the"responsible disc"by some invasive checks such as CT discography and zygapophysial joint block. In this study,we can provide a new way for this disease, combining CT discograpy and zygapophysial joint block for diagnosing and treating degenerative low back pain.Methods: These patients of the degenerative low back pain whose clinical symptoms, signs and CT, MRI examination do not match and the patients whose CT, MRI examination revealed multiple-segment lesions need to be identified the"responsible disc"to determine the treatment, eliminating tuberculosis,cancer and other diseases,have to do CT discography and zygapophysial joint block examination. According to the results, the appropriate surgical treatment is given to the patient after the definite diagnosis. By a form of self-control, matching design method, compared the preoperative of the JOA and VAS criterion with the post-operative of the JOA and VAS criterion recently(1 month), we studied the effect of CT discography and zygapophysial joint block in diagnosing and treating degenerative low back pain.Results:1. CT discography resultsCT discography results were performed 93 discs,the positive 39 discs ( Two cases of preoperative MRI signal change in two segments but CT discography in one segment. One cases of preoperative MRI signal changes in one segments but CT discography in two segments.).2. Zygapophysial joint block resultsZygapophysial joint block resultsed in the closure of a facet joint closed 54. The positive results of four cases, one case of the preoperative MRI signal no change in segments, three cases of the preoperative MRI signal change in segment, but the discography negative results.3. Surgical treatment of segment resultswe performed on the positive discography and the positive zygapophysial joint block with posterior disc kectomy integrate the intervertebral plate fusion and the pedicle screw fixation rod system,a total of 31 cases of surgical treatment in patients with a total of 51 intervertebral discs. Signal fusion in 18 cases, multi-segment fusion in 12 cases.4. Clinical Evaluation ResultsClinical results of comprehensive evaluation of all patients are conscious of improvement of their life's quality dramatically after surgical treatment(1 month).Statistics shows that patients of the pre-operative and post-operative are different significantly.5. ComplicationsThe pain of four patients in leg and lumbar aggravate in CT discography after operation. The symptoms of 11 cases in low back pain aggravate immediately,but release in one week. All the patients had no complications in the near future.Conclusions: CT discography and zygapophysial joint block can be better used in diagnosis and treatment of degenerative low back pain. For discogenic low back pain and zygapophysial joint pain can play a definite role in the diagnosis and differential diagnosis. For multi-segments of spinal degeneration, the segments of disease can be clearly determined , guiding surgical treatment.