In childhood, osseous fusion may developed after discitis
2.
Our case sometimes had low back pain during childhood, but
she had no history of other symptoms of discitis
2. Lumbar
fusion may be congenital in our case because tethered cord
may be seen with congenital spine deformities
4. Our case
may be a progressive noninfectious anterior vertebral fusion
1. So, we did not know that anterior lumbar fusion was
congenital or acquired in our case, and we classified it as
idiopathic anterior lumbar body fusion.
Major symptom of our case was low-back pain. Many
spine surgeons believe that discography is indicated to
determine whether a disc that appears abnormal on MRI is a
source of pain 5,6,8,9. Discography is not a routine test and
remains controversial 10. In our case, lumbar discs were
abnormal on MRI and we classified the low-back pain as
discogenic without performing the discography.
Tethered cord is a pathologic fixation of the spinal cord
and it may be symptomatic or asymptomatic, and untethering
is unnecessary in all cases 4,11. Tethered cord without
neurological and urological symptoms may be treated
conservatively 11. In contrast to neurological and urological
symptoms, pain symptom was never the sole indication for
surgery for tethered cord 11 and our case had only low back
pain which we classified it as discogenic. So, our case was
treated conservatively for tethered cord.
In the treatment of patients with disabling low-back pain,
combined anterior and posterior lumbar fusion has become a
standard operative procedure 12-14. The advantage of this
combined fusion is removal of disc space movement which is a
pain source 12-14. In our case, there was idiopathic anterior
lumbar body fusion with disabling low back pain which not
resolved with conservative treatment. We made bilateral
posterolateral lumbar fusion for prevent the disc space
movement and pain relief. Our case had minimal low back
pain at the end of 2-years follow-up period.
Discogenic pain may arising from within the fused
segment of the spine 5,7. One explanation for discogenic
pain in a solid fusion is that micromotion of the fused
segments allows for mechanical stimulation of disrupted discs
15. The treatment of discogenic pain also is controversial.
Several longitudinal studies strongly suggest that fusion is
useful for discogenic pain 5,8,9. Posterolateral lumbar fusion
increases axial stiffness by only 40% and anterior interbody
fusion increases stiffness by 80% 15. It is showed that
combined anterior and posterior fusions were successful for
pain relief for discogenic pain 5-7. Colhoun et al performed
varying combinations of anterior or posterior fusion for
discogenic pain with a success rate of 52% to 89% 6.
Weatherly et al performed anterior interbody fusion in four
patients with low back pain in the presence of a solid
posterolateral lumbar fusion and all of them had complete
relief of pain 7. Barrick et al performed anterior interbody
fusion in 18 cases for discogenic pain in the presence of a solid
posterolateral lumbar fusion and pain improved in 16 cases 5.
If disabling discogenic low back pain associated with
anterior vertebral fusion and conservative treatment is failed,
bilateral posterolateral fusion is a good choice for relieving
symptoms.
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