Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 6: Discography for patient selection

Author:

Eck Jason C.1,Sharan Alok2,Resnick Daniel K.3,Watters William C.4,Ghogawala Zoher5,Dailey Andrew T.6,Mummaneni Praveen V.7,Groff Michael W.8,Wang Jeffrey C.9,Choudhri Tanvir F.10,Dhall Sanjay S.7,Kaiser Michael G.11

Affiliation:

1. Center for Sports Medicine and Orthopaedics, Chattanooga, Tennessee;

2. Department of Orthopaedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York;

3. Department of Neurosurgery, University of Wisconsin, Madison, Wisconsin;

4. Bone and Joint Clinic of Houston, Houston, Texas;

5. Alan and Jacqueline Stuart Spine Research Center, Department of Neurosurgery, Lahey Clinic, Burlington, and Tufts University School of Medicine, Boston, Massachusetts;

6. Department of Neurosurgery, University of Utah, Salt Lake City, Utah;

7. Department of Neurological Surgery, University of California, San Francisco, California;

8. Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts;

9. Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California;

10. Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York; and

11. Department of Neurosurgery, Columbia University, New York, New York

Abstract

Identifying the etiology of pain for patients suffering from chronic low-back pain remains problematic. Noninvasive imaging modalities, used in isolation, have not consistently provided sufficient evidence to support performance of a lumbar fusion. Provocative testing has been used as an adjunct in this assessment, either alone or in combination with other modalities, to enhance the diagnostic capabilities when evaluating patients with low-back pain. There have been a limited number of studies investigating this topic since the publication of the original guidelines. Based primarily on retrospective studies, discography, as a stand-alone test, is not recommended to formulate treatment strategies for patients with low-back pain. A single randomized cohort study demonstrated an improved potential of discoblock over discography as a predictor of success following lumbar fusion. It is therefore recommended that discoblock be considered as a diagnostic option. There is a possibility, based on a matched cohort study, that an association exists between progression of degenerative disc disease and the performance of a provocative discogram. It is therefore recommended that patients be counseled regarding this potential development prior to undergoing discography.

Publisher

Journal of Neurosurgery Publishing Group (JNSPG)

Subject

General Medicine

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