Yonsei Med J.  2014 Mar;55(2):487-492.

Injection of Bupivacaine into Disc Space to Detect Painful Nonunion after Anterior Lumbar Interbody Fusion (ALIF) Surgery in Patients with Discogenic Low Back Pain

• Kimura S
• Ohtori S
• Orita S
• Inoue G
• Eguchi Y
• Takaso M
• Ochiai N
• Kuniyoshi
• Aoki Y
• Ishikawa T
• Miyagi M
• Kamoda H
• Suzuki M
• Sakuma Y
• Kubota G
• Oikawa Y
• Inage K
• Sainoh T
• Yamauchi K
• Toyone T
• Nakamura J
• Kishida S
• Sato J
• Takahashi

Abstract

PURPOSE
Bupivacaine is commonly used for the treatment of back pain and the diagnosis of its origin. Nonunion is sometimes observed after spinal fusion surgery; however, whether the nonunion causes pain is controversial. In the current study, we aimed to detect painful nonunion by injecting bupivacaine into the disc space of patients with nonunion after anterior lumbar interbody fusion (ALIF) surgery for discogenic low back pain.
MATERIALS AND METHODS
From 52 patients with low back pain, we selected 42 who showed disc degeneration at only one level (L4-L5 or L5-S1) on magnetic resonance imaging and were diagnosed by pain provocation on discography and pain relief by discoblock (the injection of bupivacaine). They underwent ALIF surgery. If the patients showed low back pain and nonunion 2 years after surgery, we injected bupivacaine into the nonunion disc space. Patients showing pain relief after injection of bupivacaine underwent additional posterior fixation using pedicle screws. These patients were followed up 2 years after the revision surgery.
RESULTS
Of the 42 patient subjects, 7 showed nonunion. Four of them did not show low back pain; whereas 3 showed moderate or severe low back pain. These 3 patients showed pain reduction after injection of bupivacaine into their nonunion disc space and underwent additional posterior fixation. They showed bony union and pain relief 2 years after the revision surgery.
CONCLUSION
Injection of bupivacaine into the nonunion disc space after ALIF surgery for discogenic low back pain is useful for diagnosis of the origin of pain.

Keyword

Lumbar; spine; bupivacaine; pain; intervertebral disc

MeSH Terms

Back Pain
Bupivacaine*
Diagnosis
Humans
Intervertebral Disc
Intervertebral Disc Degeneration
Low Back Pain*
Magnetic Resonance Imaging
Methods
Spinal Fusion
Spine
Bupivacaine

Figure

• 

  Fig. 1 A 35-year-old man with LBP and nonunion after ALIF surgery. Plain X-ray film images showing non-union after ALIF surgery at L5/S1 level (A). The patient showed LBP. Pain was both provoked during the discography and decreased after the discoblock (B: X-ray film, and C: CT). 2 years after revision surgery, complete union was achieved and the patient did not show pain (D: X-ray film, and E: CT). LBP, low back pain; ALIF, anterior lumbar interbody fusion.

• 

  Fig. 2 A 28-year-old woman without LBP and nonunion after ALIF surgery. (A and B) Before surgery at L5-S1. (C) Nonunion after ALIF surgery at L5-S1. LBP, low back pain; ALIF, anterior lumbar interbody fusion.

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