Affiliation:
1. Dayton Pain Med, Kettering, OH
Abstract
Background: The intervertebral disc has been implicated as an etiology of chronic spine
pain based on clinical, basic science, and epidemiological research. There is currently no way
to determine with absolute certainty whether or not the disc is a spinal pain generator. At our
current level of understanding, discography is thought of as the best tool to evaluate disc-related
pain.
Study Design: A systematic review.
Objective: To systematically assess the diagnostic accuracy of discography with respect to
chronic spinal pain.
Methods: A systematic review of the literature was performed to assess the diagnostic accuracy
of discography with respect to chronic spinal pain. Study inclusion/exclusion criteria were based
on the modern practice of discography. Selected studies were then subjected to two rating
instruments for diagnostic accuracy studies (AHRQ and QUADAS). Specific data were then culled
from these studies and tabulated. Evidence was then classified into five levels: conclusive, strong,
moderate, limited, or indeterminate.
Results: Evidence is strong for the diagnostic accuracy of discography as an imaging tool.
Evidence is also strong for the ability of discography to evoke pain. There is strong evidence
supporting the role of discography in identifying that subset of patients with lumbar discogenic
pain. There is moderate evidence supporting the role of discography in identifying a subset of
patients with cervical discogenic pain. There is limited evidence supporting the role of discography
in identifying a subset of patients with thoracic discogenic pain.
Conclusion: Discography is a useful imaging and pain evaluation tool in identifying a subset of
patients with chronic spinal pain secondary to intervertebral disc disorders.
Key words: Spinal pain, intervertebral disc, discography, pain generator, false-positives,
diagnostic accuracy
Publisher
American Society of Interventional Pain Physicians
Subject
Anesthesiology and Pain Medicine
Cited by
35 articles.
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