Spine
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Disc deterioration and pain provocation in different low-back pain syndromes was studied using computed tomography (CT) discography. Data were prospectively collected for 300 patients (816 discs). ⋯ Eighty-two percent of DH patients, 80% of DD, 56% of LS, and 59% of LRS patients had both positive discographic pain provocation and moderate or severe disc deterioration. The study indicates that intradiscal pathology plays a major role in nonspecific low-back pain syndromes.
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Records of 575 patients operated on for the first time for lumbar disc herniation have been reviewed. Four to 17 years after the operation 371 (65%) patients answered a questionnaire on number of reoperations, working capacity, lumbar or sciatic pain as well as necessity of treatment. Of these, 255 (70%) still complained of back pain, and 83 (23%) of this group complained of constant heavy pain; 172 patients (45%) have a residual sciatica; 131 (35%) are still under some kind of treatment; 47 (14%) patients are receiving a disability pension. ⋯ In the preoperative investigation, not only symptoms and neurological signs, but also the socially and personally defined career of the illness are of importance. The patients with complaints, mainly those receiving a pension, are psychologically conspicuous and show more psychopathological features as monitored by MMPI than the patients without complaints after surgery. Psychological assessment should increasingly be used in the preoperative evaluation, especially in patients who do not present an absolute indication for neurosurgical intervention.