title: Injection of bupivacaine into disc space to detect painful nonunion after anterior lumbar interbody fusion (ALIF) surgery in patients with discogenic low back pain.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan. sohtori@faculty.chiba-u.jp.
authors.forename: Seiji
authors.initials: S
authors.lastname: Kimura
authors.forename: Seiji
authors.initials: S
authors.lastname: Ohtori
authors.forename: Sumihisa
authors.initials: S
authors.lastname: Orita
authors.forename: Gen
authors.initials: G
authors.lastname: Inoue
authors.forename: Yawara
authors.initials: Y
authors.lastname: Eguchi
authors.forename: Masashi
authors.initials: M
authors.lastname: Takaso
authors.forename: Nobuyasu
authors.initials: N
authors.lastname: Ochiai
authors.forename: Kazuki
authors.initials: K
authors.lastname: Kuniyoshi
authors.forename: Yasuchika
authors.initials: Y
authors.lastname: Aoki
authors.forename: Tetsuhiro
authors.initials: T
authors.lastname: Ishikawa
authors.forename: Masayuki
authors.initials: M
authors.lastname: Miyagi
authors.forename: Hiroto
authors.initials: H
authors.lastname: Kamoda
authors.forename: Miyako
authors.initials: M
authors.lastname: Suzuki
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sakuma
authors.forename: Gou
authors.initials: G
authors.lastname: Kubota
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Oikawa
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Inage
authors.forename: Takeshi
authors.initials: T
authors.lastname: Sainoh
authors.forename: Kazuyo
authors.initials: K
authors.lastname: Yamauchi
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Toyone
authors.forename: Junichi
authors.initials: J
authors.lastname: Nakamura
authors.forename: Shunji
authors.initials: S
authors.lastname: Kishida
authors.forename: Jun
authors.initials: J
authors.lastname: Sato
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Takahashi
mesh_terms: D000293:Adolescent; D000328:Adult; D000779:Anesthetics, Local; D002045:Bupivacaine; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D007403:Intervertebral Disc / Q000000981:diagnostic imaging / Q000473:pathology; D055959:Intervertebral Disc Degeneration / Q000175:diagnosis / Q000601:surgery; D017116:Low Back Pain / Q000175:diagnosis* / Q000209:etiology; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis; D011859:Radiography; D013123:Spinal Fusion / Q000009:adverse effects*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine
keywords: Lumbar; bupivacaine; intervertebral disc; pain; spine