椎盤攝影術合併高頻熱凝治療術成功減緩下背痛的病例報告

A case of low back pain successfully treated with negative discography combined with pulsed-dose radiofrequency

椎盤攝影術（discography）是下背痛病人診斷椎間盤源痛（discogenic low backpain）的好工具。可在臨床上可以提供更多有用的證據，協助治療與診斷。本個案報告重點在於呈現椎盤造影術在臨床上，除了診斷功能外，另可能有治療效果。希望藉由本個案報告的結果，幫助更多相似狀況的下背痛患者，為病人謀取最大的福祉。55歲的陳女士因超過三年的左後外側大腿疼痛來到成大醫院疼痛科就診。這次來疼痛科門診，陳女士臨床上的疼痛大約七分（不痛零分、最痛十分），位置在左後外側大腿。在核磁共振影像上可見L5S1椎間盤中央椎間盤突出（central herniation）。為更進一步確診椎間盤源痛，我們安排了椎盤造影術。術中顯影劑注射後無滲漏，因為沒有滲漏，所以我們給病人加做在第五腰椎神經根高頻熱凝治療來治療她的背痛；術後也沒有併發症發生。不過令人訝異的是，在進行椎盤造影術合併高頻熱凝治療術後，病人在回診時表示疼痛在術後有立即且顯著改善，且持續三個月以上，疼痛指數為兩分（不痛零分、最痛十分）。針對陳女士卓越的疼痛改善，我們希望用個案報告的方式呈現治療過程與結果，並討論椎盤造影術改善疼痛的可能機轉。

Background: Discography has long been used as diagnostic tool for patients suffering from chronic low back pain. It offers more clinical clues for physicians and aids future treatment planning. The aim of this case report is to reveal possible therapeutic effects other than the current well-known diagnostic features that may thereby benefit more patients with similar clinical findings. Case presentation: A 55-year-old woman presented in our pain clinic with left posterior lateral thigh and leg pain that had lasted for three years. The pain was approximately a 7 on the Visual Analogue Scale (VAS) (score ranging from 0~10, with 0 as no pain at all, and 10 as the worst pain in life). The MRI showed central herniation of the L5-S1 disc, so discography was scheduled for further confirmation of discogenic low back pain. The discography was done smoothly without contrast leakage, and no back pain was induced. Pulse-dose radiofrequency (RF) on left L5 dorsal root ganglion (DRG) was performed for further treatment. Much to our surprise, the patient revisited the pain clinic and reported a VAS reduction to 2 after the procedure. We continued follow-up, and her pain still low (VAS=3-4) even a long as three months later. However, she had gradually relapsed by her 4-month visit. Conclusion: We review the current treatment options for patients with chronic discogenic low back pain and discuss the possible mechanism of pain relief in our case.