The Transfer of Disc Pressure to Adjacent Discs in Discography

Hebelka, Hanna; Gaulitz, Arne; Nilsson, Andreas; Holm, Sture; Hansson, Tommy

doi:10.1097/brs.0b013e3181dc9e0f

Cited by 20 publications

(16 citation statements)

References 17 publications

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“…However, since intradiscal pressure during discography potentially is transferred to adjacent discs [28] and consequently might result in false positive diagnosis when pressurizing discs too much, a lower pressurization was used. O'Neill et al [17] also favors a lower pressurization when reporting 50 % false positive discograms at 25 psi above opening pressure.…”

Section: Limitationsmentioning

confidence: 99%

HIZ’s relation to axial load and low back pain: investigated with axial loaded MRI and pressure controlled discography

Hebelka

Hansson

2012

Eur Spine J

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Purpose The aims were to investigate if the detection of high-intensity zones (HIZ) is affected by axial load, and to study the correlation between HIZ and discogenic pain provoked with pressure controlled discography (PCD). Methods 41 consecutive patients with chronic low back pain, referred for discography, were included. Each patient underwent PCD, CT, MRI, and axial loaded MRI (alMRI) within 24 h. 35 patients completed all MRI sequences (140 discs). The detection of HIZ was compared between conventional MRI and alMRI. PCD was performed in 119 of the discs examined at MRI. Provoked pain at PCD was classified into four categories (none/unfamiliar/similar/ exact), with the patients' daily pain as reference, and correlated with presence of HIZ. Results AlMRI did not affect the detection of HIZ compared with conventional MRI. No significant correlation between HIZ and the 4-graded pain response at discography was found (p = 0.34), neither when combining similarly/exactly reproduced pain (p = 0.08). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of HIZ in detecting discs with exactly reproduced pain were 49, 69, 39 and 76 %. When combining similarly/exactly reproduced pain, PPV was higher but still only 70 %. Conclusions The detection of HIZ was not influenced by axial load. With strict PCD, discogenic pain can neither be confirmed when having HIZ (PPV 39 %) nor ruled out in discs without HIZ (NPV 76 %). Larger PCD studies including quantification of HIZ at conventional and alMRI are needed, before any dynamic component affected by axial load can be ruled out completely.

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Section: Limitationsmentioning

confidence: 99%

HIZ’s relation to axial load and low back pain: investigated with axial loaded MRI and pressure controlled discography

Hebelka

Hansson

2012

Eur Spine J

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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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“…176 Additionally, it can be coated with radiopaque material to be used in x-ray studies. 176 Some studies reported its use in pigs, 177,178 rabbits, 179 and human cadaveric spines. 180 In the case of the Radi Medical Systems sensor, it was used to monitor intradiscal pressure in sedated pigs 181 and patients suffering from lumbar back pain.…”

Section: Intra-articular Pressurementioning

confidence: 99%

Review of fiber-optic pressure sensors for biomedical and biomechanical applications

Roriz

Frazão

Ribeiro³

et al. 2013

J. Biomed. Opt

192

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Abstract. As optical fibers revolutionize the way data is carried in telecommunications, the same is happening in the world of sensing. Fiber-optic sensors (FOS) rely on the principle of changing the properties of light that propagate in the fiber due to the effect of a specific physical or chemical parameter. We demonstrate the potentialities of this sensing concept to assess pressure in biomedical and biomechanical applications. FOSs are introduced after an overview of conventional sensors that are being used in the field. Pointing out their limitations, particularly as minimally invasive sensors, is also the starting point to argue FOSs are an alternative or a substitution technology. Even so, this technology will be more or less effective depending on the efforts to present more affordable turnkey solutions and peer-reviewed papers reporting in vivo experiments and clinical trials. © The Authors. Published by SPIE under a Creative Commons Attribution 3.0 Unported License. Distribution or reproduction of this work in whole or in part requires full attribution of the original publication, including its DOI.

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The Transfer of Disc Pressure to Adjacent Discs in Discography

Abstract: Discography of porcine discs induces a pressure increase in adjacent discs. A similar pressure transfer during human clinical discography might elicit false-positive pain reactions.

Cited by 20 publications

References 17 publications

HIZ’s relation to axial load and low back pain: investigated with axial loaded MRI and pressure controlled discography

HIZ’s relation to axial load and low back pain: investigated with axial loaded MRI and pressure controlled discography

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

Review of fiber-optic pressure sensors for biomedical and biomechanical applications

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