2. 70-80% of the U.S. population
eventually experiences back-pain
* only 15% of back-pain patients have a
definitive diagnosis
* many patients carry a diagnosis of
chronic sprain or strain
Von Korff M, Saunders K The course of back Pain in
primary care. Spine 21:2833-9,1996
Wahlgren DR et al. One year follow up of first onset low
back pain. Pain 73:213-221,1997
3. Epidemiology
• 70-80% of the U.S. population eventually
experiences back-pain
• Only 15% of back-pain patients have a definitive
diagnosis
• Many patients carry a diagnosis of chronic
sprain or strain
Von Korff M, Saunders K The course of back Pain in primary care. Spine
21:2833-9,1996
Wahlgren DR et al. One year follow up of first onset low back pain. Pain
73:213-221,1997
4. Why is Specific Diagnosis Elusive?
Low back Pain Spine Pain
• Initial short term recovery • Clinical examination is often
70-80% non-focal
• At one year follow up 25-48% • Imaging studies often may not
will report recurrence correlate with clinical pain
syndromes
• 13-15% will have moderate to
severe chronic pain • Red flag conditions are usually
evident by history and clinical
examination such as acute
Von Korff M, Saunders K The course of back Pain in
primary care. Spine 21:2833-9,1996
neurological deficit require
Wahlgren DR et al. One year follow up of first onset low immediate medical attention
back pain. Pain 73:213-221,1997
17. Facet Referred Pain
Gluteal
Trochanteric
Proximal thigh
Groin
Lumbar
Considerable overlap
Fukui s, Ohseto K, Shiotani M, Ohno K,
Karasawa H, Naganuma Y. Distribution of
referred pain from lumbar zygapophyseal
joints and dorsal rami. Clin J Pain
13:303-307,1997
19. Diagnosing Facet Syndrome
Neither clinical
examination nor
imaging is reliable
for diagnosis of facet
syndrome
•Diagnostic
Injections is gold
standard
Schwarzer A, Derby R, Aprill CN et al. Pain from lumbar zygapophyseal joints. A test of
two models J Spine Dis 7:331-8:1994
28. Facet Injections
• Radio frequency ablation medial branch
provides most definitive treatment
Dryfuss P, Holbrook B, Pauza K, Joshi A, McLarty J, Bogduk N.
Efficacy and validity of radiofrequency neurotomy for chronic lumbar
zygapophysial joint pain. Spine 25:1270-7,2000
Lord SM, Barnsley L, Wallis BJ and Bogduk N. A randomized double
blinded controlled trial of percutaneous radiofrequency neurotomy
for the treatment of chronic cervical zygapophysial joint pain. N
Engl J Med 335:1721-1726,1996
36. I.D.D. = AXIAL BACK PAIN
• THEORETICALLY A CONSTANT
DEEP ACHING PAIN IS PRESENT
SECONDARY TO CHEMICAL
NOCICEPTION THAT IS
AGGRAVATED BY ANY MOVEMENT
THAT MECHANICALLY STRESSES
THE AFFECTED DISC
• HIP PAIN, THIGH PAIN, GROIN PAIN
39. DIAGNOSTIC
DISCOGRAPHY
• The role of diagnostic discography is to
identify a pathological and painful disc
and distinguish it from a disc that is not
painful.
• Diagnostic discography provides
information about the structure and
sensitivity of discs that can not be
obtained from any other source.
• It is a highly reliable and specific dx.
test when performed correctly.