Provocative discography in volunteer subjects with mild persistent low back pain

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

“…12,25 Subjective concordance has been an unreliable back-stop to discriminate between pain injections that are clinically important and those that are not. 8,12,25 In the current study, the authors examined prior experimental results to determine if painful disc injections occur in that subset of asymptomatic subjects at low pressure, as defined by the cluster analysis of O'Neill et al 5 By revisiting a subset of data from prior studies, we may now address the hypothesis that a low-pressure criterion eliminates the risk of false positives (i.e., if the criterion of "low pressure" is added to the Walsh et al 7 criteria of pain, morphology, and control criteria, then positive disc injections should not be seen in subjects without LPB illness). In the current study, an experimental volunteer group of subjects asymptomatic for LBP had approximately the same percentage of painful injections at low pressure during Discography as did a symptomatic control group.…”

“…8 The defining common characteristic of the 69 subjects for purposes of the current study is that they underwent lumbar Discography under a uniform protocol while being asymptomatic for significant LBP for at least 6 months before the experimental Discography. These 69 subjects represent all subjects in the consecutive series without chronic LBP illness tested in these series of experimental studies on Discography at our institution.…”

Does Minor Trauma Cause Serious Low Back Illness?

“…Consecutive patients seen for cervical disc disease at the Stanford University Hospital were assessed for concurrent LBP symptoms as part of a study of cervical disc herniations. [15][16][17] As described in previous publications, patients were screened, and subjects without low back symptoms or those who described LBP symptoms as mild and not associated with any functional loss or medical treatment, were recruited. For this cohort, only working subjects were recruited, excluding some subjects in the original group who were occupationally disabled at baseline, to complete the full cohort of 200 subjects.…”

Discography

“…A falsepositive rate of 36% per patient was reported. 18 Secondary analysis applying ISIS/ IASP standards found a false-positive rate of 16% per patient. 12 This increased false-positive rate is likely a result of some of these results actually being truepositives.…”