LUMBAR DISC VACUUM PHENOMENON: ITS CLINICAL IMPLICATIONS AND SURGICAL TREATMENT

In this paper, we describe the clinical symptoms, diagnosis, and surgical treatment of painful lumbar discs with the vacuum phenomenon (VP). The sole indication for anterior arthrodesis was painful discs with VP. Sixteen patients were included and retrospectively reviewed; of these, 10 patients had back and thigh claudication pain, and 5 patients had acute onset of excruciating back or thigh pain. Unilateral thigh pain tended to be on the concave side of lumbar scoliosis. Dynamic myelography and reformatted computed tomography (CT) were useful imaging tools to detect VP. Bone scan was useful in detecting painful discs in degenerative scoliosis, and selective nerve block was useful in differentiating compressive root pain. Mechanical and chemical factors were postulated for the pathogenesis of VP discs in patients with chronic and acute pain. Satisfactory outcomes were achieved in 94% (n = 15) of patients by anterior arthrodesis with cage. VP is a useful pain and fusion indicator in painful spine with or without deformities. The term "discogenic claudication" is proposed to describe clinical pictures of the vacuum sign.