Pressure Increase in Adjacent Discs During Clinical Discography Questions the Methods Validity

Hebelka, Hanna; Nilsson, Andreas; Hansson, Tommy

doi:10.1097/brs.0000000000000166

Cited by 16 publications

(17 citation statements)

References 30 publications

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“…Furthermore, studies have shown that the degenerative process within a disc can be initiated with a mere needle puncture (ie, that performed during lumbar discography) [41][42][43][44][45][46][47][48][49][50]. A recent study has demonstrated pressure increases in adjacent level discs during lumbar discography, which similarly led the authors to the conclusion to question the method's validity [51]. Therefore, discography was not used as a diagnostic tool in the present study.…”

Section: Preoperative Diagnosis and Patient Selectionmentioning

confidence: 86%

Mid- to long-term results of total lumbar disc replacement: a prospective analysis with 5- to 10-year follow-up

Siepe¹,

Heider²,

Wiechert³

et al. 2014

The Spine Journal

102

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Section: Preoperative Diagnosis and Patient Selectionmentioning

confidence: 86%

Mid- to long-term results of total lumbar disc replacement: a prospective analysis with 5- to 10-year follow-up

Siepe¹,

Heider²,

Wiechert³

et al. 2014

The Spine Journal

102

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“…This state, discogenic pain, is reported by some to be reliably revealed by concordant pain reaction at discography [17][18][19][20][21], but others are in disagreement [22][23][24]. When using this test procedure Schwarzer et al [19] were unable to differentiate patients with discogenic pain clinically from other patients within the CLBP population.…”

Section: Discussionmentioning

confidence: 96%

“…Logically, provocative discography would be the most suitable test for pinpointing a painful disc, and several reports defend this opinion [17][18][19][20][21][28][29][30][31] while others do not [22][23][24]31,32]. In fusion surgery in patients suffering from non-specific CLBP Madan et al [22] and Carragee et al [23] did not find pain reaction at discography to be a reliable method for pinpointing a presumed painful disc.…”

Section: Discussionmentioning

confidence: 99%

Symptoms and signs possibly indicating segmental, discogenic pain. A fusion study with 18 years of follow-up

Nyström¹,

Weber

Schillberg³

et al. 2017

Scandinavian Journal of Pain

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AbstractBackgroundOnly two out of the five existing randomized studies have reported better results from fusion surgery for chronic low back pain (CLBP) compared to conservative treatment. In these studies the back symptoms of the patients were described simply as “chronic low back pain”. One possible reason for the modest results of surgery is the lack of a description of specified symptoms that might be related to a painful segment/disc, and patient selection may therefore be more or less a matter of chance. Previous prospective studies including facet joint injections and discography and eventually MRI have failed to identify patients with a painful segment/disc that will benefit from fusion surgery.PurposeOur purpose was to analyse in detail the pre-operative symptoms and signs presented by patients who showed substantial relief from their back pain following spinal fusion surgery with the aim of possibly finding a pain pattern indicating segmental, discogenic pain.MethodsWe analysed 40 consecutive patients, mean age 41 years, with a history of disabling low back pain for a mean of 7.7 years. Before surgery the patients completed a detailed questionnaire concerning various aspects of their back pain, and findings at clinical examination were thoroughly noted. Monosegmental posterior lumbar interbody fusion without internal fixation was performed using microsurgical technique. Outcome was assessed at 1, 2 and 4 years after surgery and finally at 18 years, using selfreporting measures and assessment by an independent examiner. Assessment at 18 years applied the Balanced Inventory for Spinal Disorders Questionnaire and the Roland-Morris Disability Questionnaire.ResultsAccording to the independent observer’s assessment at two years 27 of the 40 patients were much improved. Analysis of the pre-operative depiction of the back symptoms of this group revealed a rather uniform pattern, the most important being: dominating back pain originating in the midline of the spine, with a dull, aching character and stabbing pain in the same area provoked by sudden movements. Most patients in this group also had diffuse pain radiation of various extension down one or both legs and often bladder dysfunction with frequency. At clinical examination, localized interspinal tenderness was observed within the spinal area in question and the patient’s back pain was provoked by pressure in that area and by tapping a neighbouring spinous process.At 18 years after surgery 19 patients assessed themselves as much improved. At that time 5 of them had pension due to age, 7 early pension, one worked full time and six patients part time. Eleven patients were re-operated due to defect bony healing.ConclusionsThe results may suggest that the use of a detailed symptom analysis and clinical examination may make it possible to select a subgroup of patients within the CLBP group likely to have better outcome following fusion surgery.ImplicationsThe next step would be to execute prospective studies and if our findings concerning back pain details and signs among CLPB patients can be confirmed this can provide for more accurate selection of patients suitable for fusion surgery.

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“…It has also been suggested that the injected contrast agent in itself may cause accelerated degeneration by inducing cell apoptosis [44]. In addition, it was recently demonstrated that discography-induced pressure increases not only in the injected disc, but also in adjacent discs potentially inducing false-positive responses [8][9][10]. This strongly questions the validity of discography as a tool-provoking pain on a single disc level only.…”

Section: Discussionmentioning

confidence: 97%

“…Discography remains, however, questioned due to factors such as inconclusiveness regarding false-positive responses, lack of ''gold standard'' and uncertainty of what actually causes the pain in or around the disc [3][4][5][6][7]. A recent finding that discography induces a significant pressure increase not only in the injected disc, but also in adjacent discs that further raises new questions about discography's validity [8][9][10].…”

Section: Introductionmentioning

confidence: 98%

Comparison between pain at discography and morphological disc changes at axial loaded MRI in patients with low back pain

2014

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Pressure Increase in Adjacent Discs During Clinical Discography Questions the Methods Validity

Abstract: 1.

Cited by 16 publications

References 30 publications

Mid- to long-term results of total lumbar disc replacement: a prospective analysis with 5- to 10-year follow-up

Mid- to long-term results of total lumbar disc replacement: a prospective analysis with 5- to 10-year follow-up

Symptoms and signs possibly indicating segmental, discogenic pain. A fusion study with 18 years of follow-up

Comparison between pain at discography and morphological disc changes at axial loaded MRI in patients with low back pain

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