STUDY DESIGN: Randomized trial. OBJECTIVE: To examine the difference in surgical versus nonsurgical treatment of selected patients with discogenic low back pain (DLBP). SUMMARY OF BACKGROUND DATA. Diagnosis of DLBP without leg pain is difficult and a standard method of therapy has not yet been established. There are equivocal reports of the effectiveness of surgical treatment for DLBP, but the diagnosis therein was unreliable. Therefore, we compared the effectiveness of nonsurgical and surgical therapy (anterior interbody fusion (ABF) and posterolateral fusion with pedicle screws (PLF)) for strictly-selected DLBP patients. DLBP without leg pain was strictly diagnosed in 41 low back pain patients. METHODS: The patients suffered from DLBP for an average of 7.5 years and showed disc degeneration only at 1 level (L4/5 or L5/S1) on magnetic resonance imaging, pain provocation on discography, and pain relief by anesthetic discoblock. The 41 patients were divided into 3 groups (minimal treatment control, 20 patients; ABF, 15 patients; PLF, 6 patients). Visual analog scale (VAS) score, Japanese Orthopedic Association score, and Oswestry Disability Index (ODI) were evaluated before and 2 years after therapy. RESULTS: VAS score, Japanese Orthopedic Association score, and ODI were not significantly different among the 3 groups before therapy, but were significantly improved in the 2 surgical groups compared with the minimal treatment control group 2 years after treatment (p < 0.05). The VAS score and ODI were significantly better in the ABF group than in the PLF group 2 years after treatment (p < 0.05). CONCLUSION: If DLBP is strictly diagnosed, surgical therapy is suitable for its treatment. ABF gives good results, but PLF is an option for patients for whom anterior surgery is unsuitable.
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