Systematic review of lumbar discography as a diagnostic test for chronic low back pain
- PMID: 19461822
Systematic review of lumbar discography as a diagnostic test for chronic low back pain
Abstract
Background: The intervertebral disc has been implicated as an etiology of chronic lumbar spine pain based on clinical, basic science, and epidemiological research. However, there is lack of consensus regarding the diagnosis and treatment of intervertebral disc disorders. Based on controlled evaluations, the lumbar intervertebral discs have been shown to be sources of chronic back pain without disc herniation in 26% to 39%. Lumbar provocation discography, which includes disc stimulation and morphological evaluation, is often used to distinguish a painful disc from other potential sources of pain. Despite the extensive literature, controversy continues about provocation lumbar discography.
Study design: A systematic review of the lumbar provocation discography literature.
Objectives: To systematically assess the diagnostic accuracy of lumbar discography.
Methods: A systematic review of the literature was performed to assess the diagnostic accuracy of lumbar discography with respect to chronic low back pain. Study inclusion/exclusion criteria were based on International Association for the Study of Pain (IASP) standards with pain provocation and determination of controlled discs. Selected studies were then subjected to a rating instrument for diagnostic accuracy studies. Specific data were then culled from these studies and tabulated. Quality of evidence was assessed using modified Agency for Healthcare Research and Quality (AHRQ) diagnostic accuracy evaluation. Studies meeting methodologic quality criteria scores of 50 or higher were included in the assessment of the level of evidence. Qualitative analysis was conducted using 5 levels of evidence, ranging from Level I to III, with 3 subcategories in Level II. The rating scheme was modified to evaluate the diagnostic accuracy.
Results: Based on a modified U.S. Preventive Services Task Force (USPSTF) level of evidence criteria, this systematic review indicates the strength of evidence as Level II-2 for the diagnostic accuracy of lumbar provocation discography utilizing IASP criteria.
Limitations: Limitations include a paucity of literature, poor methodologic quality, and very few studies performed utilizing IASP criteria.
Conclusion: Based on the current systematic review, lumbar provocation discography performed according to the IASP criteria with control disc (s) with minimum pain intensity of 7 of 10, or at least 70% reproduction of worst pain (i.e. worst spontaneous pain of 7 = 7 x 70% = 5) may be a useful tool for evaluating chronic lumbar discogenic pain. Discography is an important imaging and pain evaluation tool in identifying a subset of patients with chronic low back pain secondary to intervertebral disc disorders.
Similar articles
-
Systematic review of cervical discography as a diagnostic test for chronic spinal pain.Pain Physician. 2009 Mar-Apr;12(2):305-21. Pain Physician. 2009. PMID: 19305482 Review.
-
An update of the appraisal of the accuracy and utility of cervical discography in chronic neck pain.Pain Physician. 2012 Nov-Dec;15(6):E777-806. Pain Physician. 2012. PMID: 23159976 Review.
-
An Update of the Systematic Appraisal of the Accuracy and Utility of Discography in Chronic Spinal Pain.Pain Physician. 2018 Mar;21(2):91-110. Pain Physician. 2018. PMID: 29565943
-
An update of the systematic appraisal of the accuracy and utility of lumbar discography in chronic low back pain.Pain Physician. 2013 Apr;16(2 Suppl):SE55-95. Pain Physician. 2013. PMID: 23615887 Review.
-
Decision making in surgical treatment of chronic low back pain: the performance of prognostic tests to select patients for lumbar spinal fusion.Acta Orthop Suppl. 2013 Feb;84(349):1-35. doi: 10.3109/17453674.2012.753565. Acta Orthop Suppl. 2013. PMID: 23427903
Cited by
-
Review: Discogenic Back Pain: Update on Treatment.Orthop Rev (Pavia). 2023 Aug 25;15:84649. doi: 10.52965/001c.84649. eCollection 2023. Orthop Rev (Pavia). 2023. PMID: 37641793 Free PMC article.
-
Can sinuvertebral nerve block be used for the treatment of discogenic low back pain?-Look before you leap.Ann Transl Med. 2023 Mar 15;11(5):233. doi: 10.21037/atm-22-6395. Epub 2023 Feb 22. Ann Transl Med. 2023. PMID: 37007578 Free PMC article. No abstract available.
-
The association of modic changes and chronic low back pain: A systematic review.J Orthop. 2022 Nov 17;35:99-106. doi: 10.1016/j.jor.2022.11.003. eCollection 2023 Jan. J Orthop. 2022. PMID: 36438174 Free PMC article. Review.
-
Effect of species, concentration and volume of local anesthetics on intervertebral disk degeneration in rats with discoblock.Eur Spine J. 2022 Nov;31(11):2960-2971. doi: 10.1007/s00586-022-07398-2. Epub 2022 Sep 24. Eur Spine J. 2022. PMID: 36152221
-
Predictors of discogenic pain in magnetic resonance imaging: a retrospective study of provocative discography performed by posterolateral approach.Korean J Pain. 2021 Oct 1;34(4):447-453. doi: 10.3344/kjp.2021.34.4.447. Korean J Pain. 2021. PMID: 34593662 Free PMC article.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources