Spinal Probing: A New Diagnostic Technique for Back Pain
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Introduction
Low back pain is a major health and economic issue. Diagnosis and treatment of low back pain are extremely difficult. With the application of modern diagnostic tools such as CT scan, MRI, myelogram, and nerve electric diagnostic tests, the accuracy for low back pain diagnosis has improved. However, it is a common belief that 80% of the low back pain sufferers still can not have accurate diagnoses. Inaccurate diagnosis of pain sources is a key cause for treatment failure, including physical, medical, and surgical means.
Recently, provocative discography becomes popular for the diagnosis of discogenic pain. However, discography is ineffective for diagnosis of non discogenic pain. It has been found that many pain sources are from intervetebral formainal structures, such as osteophytes, bone spurs, scar tissue, inflamed tissues, and facet joint hypertrophy. To confirm the pain sources in the foraminal area, current image studies including CT, MRI, and myleography are ineffective neither.
Recently, Martin Knight in UK and Anthony Yeung in the US have applied a new technique, namely spinal probing, for the diagnosis of pain sources in the formainal structures. Furthermore, after removal of the pain sources endoscopically, the patients have had significant pain relief and improved functional status and life quality. The patients who have been benefited from these pioneering studies include those with severe degenerative diseases, spinal stenosis, foraminal stenosis, slippage of vertebrates, disc herniations, and failed back surgery syndrome.
Technique
Under the light sedation, the patient is positioned in prone on to standard pain management table. Under fluoroscopic guidance, an introducing cannula is inserted to target foraminal entrance. A blunt probe is inserted through the cannula for reproducing pain by gentle probing. The introducing cannula is repositioned to different locations but will be parked in the foraminal entrance. The foraminal contents located at superior foraminal notch, subarticular zone, and inferior foraminal notch are tested. Anterior facet margins and posterior disc annular tissues are probed as well. During entire testing, the patient will be competent to report pain response under gentle sedation. Each pain response will be recorded in situ. The risk and complications theoretically include infections, bleeding, spinal nerve injury, spinal cord injury, and other injuries.
Publications
- M.T.N. Knight: Endoscopically Determined Pain Sources; in Lasers in the Musculoskeletal System, eds: B.E. Gerber, M, Knight, W.E. Siebert; page 267-276
- A, Yeung, C. Yeung: In-vivo endoscopic visualization of patho-anatomy in painful degenerative conditions of the lumbar spine. Surg Technol Int. 2006;15:243-56
Kaixuan Liu MD, PhD
Bryan Massoud, MD
Rae Aranas, MD