The Ability of Pressure-Controlled Discography to Predict Surgical and Nonsurgical Outcomes

Derby, Richard; Mw, Howard; Jm, Grant; Jj, Lettice; Pk, Van Peteghem; Ryan, Devon P.

doi:10.1097/00007632-199902150-00014

Cited by 239 publications

(130 citation statements)

References 17 publications

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“…Currently, discography combined with CT (post-discography CT), has the ability to demonstrate changes in internal disc architecture 2,21) . Pain responses concordant with symptoms are regarded as positive regardless of morphological abnormalities shown in discograms or post-discography CT 7,9,15) . High resolution MRI or CT techniques are excellent for visualizing morpho- 24.1 ± 14.5…”

Section: Discussionmentioning

confidence: 99%

“…Still, they are insufficient in demonstrating the fine architecture of intervertebral discs or acquiring physiological pain responses. For these reasons, discography armed with pressure-controlled techniques was developed to refine the technique 8,9,20) . Provocative discography can categorize pain responses based on discogenic pain mechanisms and decrease false positive results.…”

Section: Discussionmentioning

confidence: 99%

“…However, the validity of provocative discography as a diagnostic test in chronic LBP remains unproven; several studies have demonstrated that false positive responses can be induced in selected patients without low back symptoms 4) . Therefore, it has been suggested that low pressure injection would effectively eliminate the risk of significant pain from injection in asymptomatic individuals 9) . Recently, Seo et al 19) reported that injection speed is a confounding factor in the misinterpretation of discography.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, the validity and reliability of discography have been questioned 6) . As it is critical to avoid false positive results in LBP diagnosis, many factors have been studied in the interpretation of discography, including an abnormal psychometric test, low-pressure dye injection and the pain threshold 5,9) . However, the risk of false positive result remains similar.…”

Section: Introductionmentioning

confidence: 99%

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Automated Pressure-Controlled Discography with Constant Injection Speed and Real-Time Pressure Measurement

Kim

Shin

2009

J Korean Neurosurg Soc

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Objective : This study was designed to investigate automated pressure-controlled discography (APCD) findings, to calculate the elastance of intervertebral discs, and to assess the relationship between the calculated elastance and disc degeneration. Methods : APCD was performed in 19 patients. There were a total of 49 intervertebral discs treated. Following intradiscal puncture, a dye was constantly injected and the intradiscal pressure was continuously measured. The elastance of the intervertebral disc was defined as unit change in intradiscal pressure per fractional change in injected dye volume. Disc degeneration was graded using a modified Dallas discogram scale. Results :The mean elastance was 43.0 ± 9.6 psi/mL in Grade 0, 39.5 ± 8.3 psi/mL in Grade 1, 30.5 ± 22.3 psi/mL in Grade 2, 30.5 ± 22.3 psi/mL in Grade 3, 13.2 ± 8.3 psi/mL in Grade 4 and 6.9 ± 3.8 psi/mL in Grade 5. The elastance showed significant negative correlation with the degree of degeneration (R 2 = 0.529, p = 0.000). Conclusion : APCD liberates the examiner from the data acquisition process during discography. This will likely improve the quality of data and the reliability of discography. Elastance could be used as an indicator of disc degeneration.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Automated Pressure-Controlled Discography with Constant Injection Speed and Real-Time Pressure Measurement

Kim

Shin

2009

J Korean Neurosurg Soc

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“…It is a subjective test relying on the radiologists' and patients' perceptions to determine the result. [29][30][31][32][33][34][35][36] Many patients with such complaints have associated psychological or psychiatric disturbances which may or may not be associated with medicolegal factors. All of these decrease their ability to give an accurate opinion as to whether the pain produced at discography is that of which they are complaining.…”

Section: Discussionmentioning

confidence: 99%

Intervertebral discs which cause low back pain secrete high levels of proinflammatory mediators

Burke

Watson

McCormack

et al. 2002

The Journal of Bone and Joint Surgery. British volume

334

248

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H erniated intervertebral disc tissue has been shownto produce a number of proinflammatory mediators and cytokines, but there have been no similar studies using discs from patients with discogenic low back pain.We have compared the levels of production of interleukin-6 (IL-6), interleukin-8 (IL-8) and prostaglandin E 2 (PGE 2 ) in disc tissue from patients undergoing discectomy for sciatica (63) with that from patients undergoing fusion for discogenic low back pain (20) using an enzyme-linked immunoabsorbent assay.There was a statistically significant difference between levels of production of IL-6 and IL-8 in the sciatica and low back pain groups (p < 0.006 and p < 0.003, respectively).The high levels of proinflammatory mediator found in disc tissue from patients undergoing fusion suggest that production of proinflammatory mediators within the nucleus pulposus may be a major factor in the genesis of a painful lumbar disc. [Br] 2002;84-B:196-201. J Bone Joint Surg Received 8 June 2001; Accepted 3 August 2001The pathophysiology of discogenic low back pain is incompletely understood. 1 The changes which occur as a disc degenerates are well documented, but are unhelpful in determining whether a degenerate disc will cause pain.2 It is known that disc tissue from patients undergoing discectomy for sciatica synthesises proinflammatory mediators and cytokines. 3-12 Sequestrated and extruded discs produce higher levels of these mediators than specimens in which the annulus is intact. 5,10,12,13 To date, there have been no studies of the production of inflammatory mediators in disc tissue from patients undergoing operations for discogenic low back pain. It has been shown, however, that degenerate discs in these patients contain more nociceptive nerve endings in the endplates of the disc and in the nucleus pulposus than do degenerate discs which do not cause low back pain. 14, 15 We have therefore compared levels of production of the proinflammatory mediators tumour necrosis factor alpha (TNF␣), interleukin-1beta (IL-1␤), interleukin-6 (IL-6), interleukin-8 (IL-8) and prostaglandin E 2 (PGE 2 ), in disc tissue from patients undergoing discectomy for sciatica with those from patients undergoing fusion for discogenic low back pain. Patients and MethodsWe obtained specimens of intervertebral disc from 63 patients undergoing primary lumbar discectomy for sciatica. Intraoperative assessment of the morphology of the disc herniation revealed 25 in which the annulus was intact (AI), 30 in which a nuclear extrusion was present (EXT) and eight in which the nucleus was sequestrated (SEQ). The mean ages were 42 years in the AI group, 39.5 years in the EXT group and 42 years in the SEQ group. The male: female ratio in the AI, EXT and SEQ groups was 17:8, 20:10 and 6:2, respectively. Three specimens were from the L3/L4 level, 28 from the L4/L5 level and 32 from the L5/ S1 level.We also obtained disc specimens from 20 patients undergoing primary lumbar interbody fusion for discogenic low back pain, which had been confirmed by discograph...

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Discogenic Low Back Pain

Kallewaard¹,

Terheggen²,

Groen³

et al. 2011

Evidence‐Based Interventional Pain Medicine

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The Ability of Pressure-Controlled Discography to Predict Surgical and Nonsurgical Outcomes

Cited by 239 publications

References 17 publications

Automated Pressure-Controlled Discography with Constant Injection Speed and Real-Time Pressure Measurement

Automated Pressure-Controlled Discography with Constant Injection Speed and Real-Time Pressure Measurement

Intervertebral discs which cause low back pain secrete high levels of proinflammatory mediators

Discogenic Low Back Pain

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