Predictors of discogenic pain in magnetic resonance imaging: a retrospective study of provocative discography performed by posterolateral approach

Abstract

Background Provocative discography (PD) is a test that is useful in diagnosing discogenic pain (DP). In this study, to diagnose DP, we used a posterolateral approach of needle placement and followed pressure criteria laid down by the Spine Intervention Society. The aim was to identify the correlation between magnetic resonance imaging (MRI) findings (desiccation, high intensity zone and change in shape and size of the disc) and the results of PD. Methods Records of 50 patients who underwent PD for DP were analyzed. A total of 109 PDs were performed, with 54 suspect and 55 control discs. Alternate pain generators were ruled out. Results A total of 35 suspect discs were positive on PD. The mean disc pressure in the suspect disc was 31.9 ± 7.9 psi (range, 15-44). Of the 50 patients who underwent PD, 35 had positive MRI findings. A significant positive correlation was found only between disc desiccation and discography result (r = 0.6, P < 0.001). Logistic regression analysis revealed that only desiccation successfully predicted the result of discography (OR = 26.5, P < 0.001); a high intensity zone and a disc protrusion/extrusion had an OR 2.3 and 1.24, respectively. Disc desiccation of Pfirmann grade 3 or more had a sensitivity and specificity of 0.93 and 0.64 respectively in identifying painful discs; the positive likelihood ratio was 2.58 while the negative likelihood ratio was 0.11. Conclusions In patients with DP, disc desiccation is the most useful MRI feature that predicts a painful disc on PD.

Diagnostic value of the posterior talofibular ligament area for chronic lateral ankle instability

“…Third, there are several different methods to assess CLAI, such as manual anterior drawer test, stress radiography, ultrasound examination or arthroscopy have been proved to be effective at discriminating CLAI. [24][25][26][27][28][29][30][31][32][33] However, we analyzed the PTFLCSA and PTFLT on MRI only.…”

Clinical study of Microendoscopic Discectomy + Fibrous Ring Suture Versus Microendoscopic Discectomy alone in the treatment of lumbar disc herniation in young and middle-aged patients

“…The size of the epidural indentation of the lumbar disc in the operated segment was measured on MRI before and after surgery, and the Pfirrmann grading of disc degeneration was performed at the same time. 9 , 10 …”

“…The size of the epidural indentation of the lumbar disc in the operated segment was measured on MRI before and after surgery, and the Pfirrmann grading of disc degeneration was performed at the same time. 9,10 Statistical analysis: All data in this study were statistically analyzed using SPSS20.0 software, and the measurement data were expressed as ( ). Two independent sample t test was employed for comparison between the two groups, and paired t-test was utilized for comparison of pre-and-post-operative parameters within the groups.…”