Treatment of Internal Disc Derangement by Posterior Lumbar Interbody Fusion and Posterior Instrumentation

  • Chul-Hyung Kang
Conference paper


Internal disc derangement (IDD) is characterized by chronic low-back pain and referred pain in the legs. This condition is easily misdiagnosed as a disc herniation, resulting in failed back surgery, or it could be ignored by a doctor as malingering or a psychological problem. The indication of surgery has been intractable low-back pain with or without leg pain in spite of conservative treatment over 6 months. Discography was performed before surgery, and painful disc(s) were identified by concordant pain provocation. Subtotal disc excision and posterior lumbar interbody fusion (PLIF) with posterior instrumentation were performed. A successful clinical and radiological result was obtained by these procedures. The cause of IDD and the mechanisms of pain are discussed.

Key words

Internal disc derangement PLIF 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Crock HV (1970) A reappraisal of intervertebral disc lesions. Med J Aust 1:983–989PubMedGoogle Scholar
  2. 2.
    Crock HV (1986) The Presidential address: ISSLS, internal disc disruption. A challenge to disc prolapse fifty years on. Spine 11:650–653PubMedGoogle Scholar
  3. 3.
    Berquist-Ullman M (1977) Acute low back pain in industry: a controlled prospective study with special reference to therapy and vocational factors. Acta Orthop Scan (Suppl) 70:1–117Google Scholar
  4. 4.
    Atlas SJ, Deyo RA, Patrick DL, et al (1996) The Quebec task force classification for spinal disorders and the severity, treatment and outcomes of sciatica and lumbar spinal stenosis. Spine 21:2885–2892PubMedGoogle Scholar
  5. 5.
    Korff MV, Saunders K (1996) The course of back pain in primary care. Spine 21:2833–2839Google Scholar
  6. 6.
    Cloward RB (1963) Lesions of intervertebral disc and their treatment by interbody fusion. Clin Orthop 27:51–77PubMedGoogle Scholar
  7. 7.
    Cloward RB (1985) Posterior lumbar interbody fusion up-dated. Clin Orthop 193:16–19PubMedGoogle Scholar
  8. 8.
    Lin PM, Cautili RA, Joyce MF (1983) Posterior lumbar interbody fusion. Clin Orthop 180:154–168PubMedGoogle Scholar
  9. 9.
    Kirkaldy-Willis WH, Wedge JH, Yong-Hing K, et al (1978) Pathology and pathogenesis of lumbar spondylosis and stenosis. Spine 3:319–328PubMedGoogle Scholar
  10. 10.
    Lee CK, Vessa P, Lee JK (1995) Chronic disabling low back pain syndrome by internal disc derangements. The clinical results of disc excision and posterior lumbar interbody fusion. Spine 20:356–361PubMedGoogle Scholar
  11. 11.
    Bogduk N, Tynan W, Wilson AS (1981) The nerve supply to human lumbar intervertebral discs. J Anat 132:29–36Google Scholar
  12. 12.
    Yoshizawa H, O’Brien JP, Smith WT, et al (1980) The neuropathology of intervertebral discs removed for low-back pain. J Pathol 132:95–104CrossRefPubMedGoogle Scholar
  13. 13.
    Blumenthal SL, Baker J, Selby DK, et al (1988) The role of anterior lumbar fusion for internal disc disruption. Spine 13:566–569PubMedGoogle Scholar
  14. 14.
    Ahmed M, Bjurholm A, Kreicbergs A, et al (1993) Neuropeptide Y, tyrosine hydroxylase and vasoactive intestinal peptides-immunoreactive nerve fibers in the vertebral bodies, discs, dura mater, and spinal ligaments of the rat lumbar spine. Spine 18:268–273PubMedGoogle Scholar
  15. 15.
    Mooney V (1987) Where is the pain coming from? Spine 12:54–59Google Scholar
  16. 16.
    Weinstein J, Claverie W, Gibson S (1988) The pain of discography. Spine 13:1344–1348PubMedGoogle Scholar
  17. 17.
    Zucherman J, Derby R, Hsu K, et al (1988) Normal magnetic resonance imaging with abnormal discography. Spine 13:1355–1359PubMedGoogle Scholar
  18. 18.
    Boden SD, Davis DO, Dina TS, et al (1990) Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg 72A:403–408Google Scholar
  19. 19.
    Aprill C, Bogduk N (1992) High-intensity zone: a diagnostic sign of painful lumbar disc on MRI. Br J Radiol 65:361–369PubMedGoogle Scholar
  20. 20.
    Schellhas KP, Pollei SR, Gundry CR, et al (1996) Lumbar disc high-intensity zone. Correlation of MRI and discography. Spine 12:276–281Google Scholar
  21. 21.
    Executive Committee of the North American Spine Society (1988) The position statement of on discography. Spine 13:1343Google Scholar
  22. 22.
    Guyer RD, Collier R, Smith WJ, et al (1988) Discitis after discography. Spine 13:1352–1353PubMedGoogle Scholar
  23. 23.
    Newman MH, Grinstead GL (1992) Anterior lumbar interbody fusion for internal disc disruption. Spine 17:831–833PubMedGoogle Scholar
  24. 24.
    Schechter NA, Lee CK (1991) Painful internal disc derangements of the lumbosacral spine: discographic diagnosis and treatment by posterior lumbar interbody fusion. Orthopedics 14:47–451Google Scholar
  25. 25.
    Weatherley CR, Prickett CF, O’Brien JP (1986) Discogenic pain persisting despite solid posterior fusion. J Bone Joint Surg 68B:142–143Google Scholar
  26. 26.
    Cinotti G, David T, Postacchini F (1996) Results of disc prosthesis after a minimum follow-up period of 2 years. Spine 21:995–1000CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Tokyo 2005

Authors and Affiliations

  • Chul-Hyung Kang
    • 1
  1. 1.Department of Orthopedic Surgery, Dongsan Medical CenterKeimyung UniversityTaeguKorea

Personalised recommendations