Comparison of discographic findings in asymptomatic subject discs and the negative discs of chronic LBP patients: Can discography distinguish asymptomatic discs among morphologically abnormal discs?

Derby, Richard; Kim, Byung Jo; Lee, Sangheon; Chen, Yung; Seo, Kwan Sik; Aprill, Charles

doi:10.1016/j.spinee.2005.01.007

Cited by 103 publications

(89 citation statements)

References 15 publications

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“…The lack of controlled pressure injection can be an important reason to the discrepancy in PPV between the current and previous reports. Uncontrolled high intradiscal pressures and injection speeds have been shown to generate false positive responses [17,18,27]. It is likely that the lack of PCD was a strong confounding factor to many of those previous results.…”

Section: Discussionmentioning

confidence: 94%

“…O'Neill et al [17] also favors a lower pressurization when reporting 50 % false positive discograms at 25 psi above opening pressure. Further, Derby et al [18] stated that mean pressure initially evoking pain in positive discograms was 20 psi, also supporting a lower pressure range. The rate of low pressure positive discograms in the current study was in accordance with Derby et al [23], who showed a rate of 15 % when using manometry.…”

Section: Limitationsmentioning

confidence: 96%

“…The importance of HIZ in discogenic low back pain (LBP) remains therefore unclear. Pressure controlled discography (PCD), now criterion standard, has not been used in the majority of the numerous studies correlating HIZ and discogenic pain [1][2][3][4][5][6][7][9][10][11][12][13][14][15][16] making previous results dubiousm, since discography without pressure registration can induce false positive responses [17,18].…”

Section: Introductionmentioning

confidence: 99%

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HIZ’s relation to axial load and low back pain: investigated with axial loaded MRI and pressure controlled discography

Hebelka

Hansson

2012

Eur Spine J

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Purpose The aims were to investigate if the detection of high-intensity zones (HIZ) is affected by axial load, and to study the correlation between HIZ and discogenic pain provoked with pressure controlled discography (PCD). Methods 41 consecutive patients with chronic low back pain, referred for discography, were included. Each patient underwent PCD, CT, MRI, and axial loaded MRI (alMRI) within 24 h. 35 patients completed all MRI sequences (140 discs). The detection of HIZ was compared between conventional MRI and alMRI. PCD was performed in 119 of the discs examined at MRI. Provoked pain at PCD was classified into four categories (none/unfamiliar/similar/ exact), with the patients' daily pain as reference, and correlated with presence of HIZ. Results AlMRI did not affect the detection of HIZ compared with conventional MRI. No significant correlation between HIZ and the 4-graded pain response at discography was found (p = 0.34), neither when combining similarly/exactly reproduced pain (p = 0.08). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of HIZ in detecting discs with exactly reproduced pain were 49, 69, 39 and 76 %. When combining similarly/exactly reproduced pain, PPV was higher but still only 70 %. Conclusions The detection of HIZ was not influenced by axial load. With strict PCD, discogenic pain can neither be confirmed when having HIZ (PPV 39 %) nor ruled out in discs without HIZ (NPV 76 %). Larger PCD studies including quantification of HIZ at conventional and alMRI are needed, before any dynamic component affected by axial load can be ruled out completely.

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Section: Discussionmentioning

confidence: 94%

Section: Limitationsmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

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HIZ’s relation to axial load and low back pain: investigated with axial loaded MRI and pressure controlled discography

Hebelka

Hansson

2012

Eur Spine J

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“…A majority of discography studies, actually even recent publications, have been performed either without controlled pressure registration 7 , 19 , 30 -40 or with maximal cutoff 100 psi above opening. 1,2,6,10,12,18,28,29,41 This high pressurization is often used when injecting negative control discs, which is recommended in discography. 15 , 29 Pressure recorded directly in NP is preferred when evaluating disc pressure but is not conventionally used because of lack of suffi ciently small and safe intradiscal transducers for human use.…”

Section: Discussionmentioning

confidence: 99%

In Vivo Discography in Degenerate Porcine Spines Revealed Pressure Transfer to Adjacent Discs

Hebelka

Nilsson

Ekström³

et al. 2013

Spine

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“…The executive Committee of the North American Spine Society deemed discography to be the only valid method for diagnosing discogenic LBP 3 . However, controversies exist concerning its accuracy and clinical significance 4,5 . The present study will summarize the results of diagnostic discography in a group of patients with LBP, and analyze its accuracy and clinical significance.…”

Section: Introductionmentioning

confidence: 99%

Analysis of the relationship between morphology of intervertebral disc and some correlated factors following discography in patients with chronic low back pain

Zhang

Xiang

et al. 2009

Orthopaedic Surgery

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Objective: To evaluate the diagnostic effectiveness of discography in discogenic low back pain (LBP).Methods: Ninety-six cases of chronic LBP with or without referred thigh pain were enrolled in this study. All these cases received CT scan following discography once conservative treatment for at least 6 months had failed. There were 42 men and 54 women, aged from 24 to 67 years (average 46.4). Discography was performed on 218 discs. The positive discs were classified morphologically according to the Dallas Discogram Description (DDD).Results: (i) The 56 cases (58.3%) which were positive on discography were divided into two subgroups of age less or more than 50 years. Positive rates for the two subgroups were 33.3% and 66.7%, respectively; (ii) one hundred and twenty-two discs, of which 62 (50.8%) were positive on discography, showed morphologic abnormality, whereas all the discography positive discs showed morphologic abnormality. No complication related to discography was found in any case. Conclusion: (i)Compared with the younger patients, older LBP patients have a lower positive rate of discography despite the presence of more serious degenerative disc changes; (ii) outer layer disruption of the annulus fibrous correlates with positive discography; (iii) MRI intensity changes are not specific in diagnosing discogenic pain. Additional discography is needed to identify the painful disc; and (iv) the contrast volume injected into discs can be affected by a variety of factors which restrict its diagnostic value.

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Comparison of discographic findings in asymptomatic subject discs and the negative discs of chronic LBP patients: Can discography distinguish asymptomatic discs among morphologically abnormal discs?

Cited by 103 publications

References 15 publications

HIZ’s relation to axial load and low back pain: investigated with axial loaded MRI and pressure controlled discography

HIZ’s relation to axial load and low back pain: investigated with axial loaded MRI and pressure controlled discography

In Vivo Discography in Degenerate Porcine Spines Revealed Pressure Transfer to Adjacent Discs

Analysis of the relationship between morphology of intervertebral disc and some correlated factors following discography in patients with chronic low back pain

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