Outcome of unoperated discogram-positive low back pain

No previous discography study has addressed the nonoperative outcome of low back pain. This study was undertaken to retrospectively analyze the outcome of patients with documented single-level discogenic pain who were considered candidates for surgery but did not receive it. The natural history of "discogenic" low back pain is unknown, and its treatment is controversial. Although positive discography is viewed as a valid diagnostic technique, the results of fusion surgery are often disappointing. Twenty-five individuals (16 women, 9 men) underwent comprehensive evaluation (examination, radiography, objective disability determination). Study criteria included incapacitating low back pain, single-level + morphologic + provocative discogram, no surgery, and a minimum follow-up period of 3 years. Average age of patients at discography was 43 years and at study was 48 years; level of involvement in 10 patients was L4-L5 and in 15 patients were L5-S1. The mean follow-up period was 4.9 years (range, 3.3-7.0 years). The condition of 17 (68%) patients improved, two (8%) stayed the same, and six (24%) worsened. Improved patients had a shorter history of low back pain (3.5 yr vs. 11.0 yr) and older age at onset (45 versus 33 yrs.) Psychiatric disease was present in 66.7% (4 of 6) patients whose conditions worsened. Eighty percent (12 of 15) of patients receiving workers' compensation improved. There was no correlation between disc level, gender, smoking, and outcome. Discogenic low back pain improved in patients without psychiatric disease. Older age at onset and shorter duration of low back pain were favorable indicators. These results are comparable with or better than those reported for surgical treatment of this condition.