Structural Etiology of Chronic Low Back Pain Due to Motor Vehicle Collision

Objective. To estimate prevalence rates of discogenic, facet, and sacroiliac joint pain, and describe clinical features of chronic low back pain patients whose symptoms were initiated by motor vehicle collisions. Design. Retrospective chart review. Setting. Academic spine center. Patients. Twenty-seven motor vehicle collision-induced chronic low back pain patients were included after undergoing diagnostic procedures. Interventions. Lumbar provocation discography, dual diagnostic facet joint blocks, and intra-articular sacroiliac joint injections. Methods. Enrolled patients underwent diagnostic procedures based on clinical presentation until the pain source was identified. The prevalence of each source of low back pain was estimated. Clinical, categorical, and continuous characteristics within the source groups were calculated with SAS v. 9.2 (SAS Institute Inc., Cary, NC). Outcome Measures. Etiology and prevalence were analyzed for each diagnosis group. Results. Of the 27 patients, 15/27 (56%) were diagnosed with discogenic pain, 7/27 (26%) with sacroiliac joint pain, and 5/27 (19%) with facet joint pain. Seventy-eight percent were female. Mean age was 42.5 years (standard deviation = 10.4) with median duration of symptoms of 24 months (interquartile range = 6-48). Conclusions. Our study is the first to demonstrate that diagnostic spinal injections can identify particular spinal structures, namely the intervertebral disc, facet joint, and sacroiliac joint, as the specific source of chronic low back pain due to inciting motor vehicle collisions. The most common source of motor vehicle collision-induced chronic low back pain appears to be the disc followed by the sacroiliac and facet joints.