Low-Pressure Positive Discography in Subjects Asymptomatic of Significant Low Back Pain Illness

Carragee, Eugene J.; Alamin, Todd F.; Carragee, John M.

doi:10.1097/01.brs.0000201242.85984.76

Cited by 111 publications

(85 citation statements)

References 23 publications

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“…These authors reported that about one-third of patients with chronic pain had a positive discography result without a history of significant lower-back problems. 1 In the present study, worse outcomes were observed in patients with a very high ODI (> 60) after lumbar arthroplasty. A low ODI has been associated with better outcomes.…”

Section: Discussionmentioning

confidence: 61%

“…Significant psychosocial overlay is a possibility. Studies by Carragee et al 1,2 in which the authors used discography extensively demonstrated the overlap between psychosocial variables and lower-back pain. These authors reported that about one-third of patients with chronic pain had a positive discography result without a history of significant lower-back problems.…”

Section: Discussionmentioning

confidence: 99%

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The predictive value of the baseline Oswestry Disability Index in lumbar disc arthroplasty

Deutsch¹

2010

FOC

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Object The goal of the study was to determine patient factors predictive of good outcome after lumbar disc arthroplasty. Specifically, the paper examines the relationship of the preoperative Oswestry Disability Index (ODI) to patient outcome at 1 year. Methods The study is a retrospective review of 20 patients undergoing a 1-level lumbar disc arthroplasty at the author's institution between 2004 and 2008. All data were collected prospectively. Data included the ODI, visual analog scale scores, and patient demographics. Results All patients underwent a 1-level disc arthroplasty at L4–5 or L5–S1. The patients were divided into 2 groups based on their baseline ODI. Patients with an ODI between 38 and 59 demonstrated better outcomes with lumbar disc arthroplasty. Only 1 (20%) of 5 patients with a baseline ODI higher than 60 reported a good outcome. In contrast, 13 (87%) of 15 patients with an ODI between 38 and 59 showed a good outcome (p = 0.03). The negative predictive value of using ODI > 60 is 60% in patients who are determined to be candidates for lumbar arthroplasty. Conclusions Lumbar arthroplasty is very effective in some patients. Other patients do not improve after surgery. The baseline ODI results are predictive of outcome in patients selected for lumbar disc arthroplasty. A baseline ODI > 60 is predictive of poor outcome. A high ODI may be indicative of psychosocial overlay.

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Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

The predictive value of the baseline Oswestry Disability Index in lumbar disc arthroplasty

Deutsch¹

2010

FOC

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“…Provocation diskography was known to be the best diagnostic method for diskogenic LBP, but there is a still debate about the role of provocation diskography for the diagnosis of diskogenic LBP. [21][22][23][24] Due to the invasive manner and possible complications such as infection, provocation diskography is not easily considered. In addition, there is no standard treatment method for diskogenic LBP even after diagnosis by provocation diskography.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic Trial of Fluoroscopic Interlaminar Epidural Steroid Injection for Axial Low Back Pain: Effectiveness and Outcome Predictors

Lee¹,

Shin²,

Park³

et al. 2010

AJNR Am J Neuroradiol

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“…There is, however, a substantial body of evidence supporting the assertion that diskography can identify a painful disk, and that the falsepositive rate for lumbar diskography, as assessed by studies of asymptomatic volunteers, is low. 4 This has been challenged in several studies, 8,9 but a systematic review of the original data for all studies of diskography in asymptomatic volunteers, with the meticulous application of manometric, patient response, and imaging criteria, found that the false-positive rate for diskography did not exceed 10%, and may be as low as 6%. 10 Interpretation of diskography responses may be more challenging in patients with multiple positive disks and in the presence of somatization disorders.…”

Section: Indications Contraindications Imaging and Performancementioning

confidence: 99%

Diagnostic and therapeutic spinal interventions

Maus

Bartleson

2014

Neur Clin Pract

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SummaryDiskography (provocation diskography, disk stimulation) is an invasive diagnostic test performed to confirm or exclude internal disk disruption as the cause of axial spine pain. Diskography involves injecting fluid into the nucleus of the disk under manometric control; a positive response is reproduction of typical pain. Extensive but indirect literature validates diskography in the lumbar spine; it is less wellsupported in the cervical or thoracic spine. Risks include rare instances of infection and neural injury; lumbar diskography may be associated with accelerated disk degeneration. Diskography has utility in establishing a diagnosis of diskogenic pain. When negative, it prevents inappropriate interventions directed at the disk; when positive, it prevents interventions directed at other axial pain generators. Its role in selecting patients for therapies directed at diskogenic pain is limited by the lack of available validated treatments.A xial spine pain is common; low back pain is estimated to affect 66%-80% and neck pain 67% of people during their life.

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Low-Pressure Positive Discography in Subjects Asymptomatic of Significant Low Back Pain Illness

Abstract: The analysis shows that the rate of low-pressure painful injections in subjects without chronic LBP illness is approximately 25%, and correlates with both anatomic and psychosocial factors. In certain subgroups, this may represent an unacceptable risk of false-positive results.

Cited by 111 publications

References 23 publications

The predictive value of the baseline Oswestry Disability Index in lumbar disc arthroplasty

The predictive value of the baseline Oswestry Disability Index in lumbar disc arthroplasty

Therapeutic Trial of Fluoroscopic Interlaminar Epidural Steroid Injection for Axial Low Back Pain: Effectiveness and Outcome Predictors

Diagnostic and therapeutic spinal interventions

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