Abstract
Background context
Provocative discography, an invasive diagnostic procedure involving disc puncture
with pressurization, is a test for presumptive discogenic pain in the lumbar spine.
The clinical validity of this test is unproven. Data from multiple animal studies
confirm that disc puncture causes early disc degeneration. A recent study identified
radiographic disc degeneration on magnetic resonance imaging (MRI) performed 10 years
later in human subjects exposed to provocative discography. The clinical effect of
this disc degeneration after provocative discography is unknown.
Purpose
The aim of this study was to investigate the clinical effects of lumbar provocative
discography on patients subjected to this evaluation method.
Study design/setting
A prospective, 10-year matched cohort study.
Patient sample
Subjects (n=75) without current low back pain (LBP) problems were recruited to participate
in a study of provocative discography at the L3–S1 discs. A closely matched control
cohort was simultaneously recruited to undergo a similar evaluation except for discography
injections.
Outcome measures
The primary outcome variables were diagnostic imaging events and lumbar disc surgery
events. The secondary outcome variables were serious LBP events, disability events,
and medical visits.
Methods
The discography subjects and control subjects were followed by serial protocol evaluations
at 1, 2, 5, and 10 years after enrollment. The lumbar disc surgery events and diagnostic
imaging (computed tomography (CT) or MRI) events were recorded. In addition, the interval
and cumulative lumbar spine events were recorded.
Results
Of the 150 subjects enrolled, 71 discography subjects and 72 control subjects completed
the baseline evaluation. At 10-year follow-up, 57 discography and 53 control subjects
completed all interval surveillance evaluations. There were 16 lumbar surgeries in
the discography group, compared with four in the control group. Medical visits, CT/MRI
examinations, work loss, and prolonged back pain episodes were all more frequent in
the discography group compared with control subjects.
Conclusion
The disc puncture and pressurized injection performed during provocative discography
can increase the risk of clinical disc problems in exposed patients.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Spine JournalAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Rates of false-positive lumbar discography in select patients without low back symptoms.Spine. 2000; 25: 1373-1381
- Provocative discography in volunteer subjects with mild persistent low back pain.Spine J. 2002; 2: 25-34
- Low-pressure positive discography in subjects asymptomatic of significant low back pain illness.Spine. 2006; 31: 505-509
- Interventional therapies, surgery, interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society.Spine. 2009; 34: 1066-1077
- Lumbar discography. Position statement from the North American Spine Society Diagnostic and Therapeutic Committee.Spine. 1995; 20: 2048-2059
- Minimally invasive induction of an early lumbar disc degeneration model in rhesus monkeys.Spine. 2013; 38: E579-E586
- Disc degeneration in the rabbit: a biomechanical and radiological comparison between four disc injury models.Spine. 2005; 30: 33-37
- Needle puncture injury affects intervertebral disc mechanics and biology in an organ culture model.Spine. 2008; 33: 235-241
- A slowly progressive and reproducible animal model of intervertebral disc degeneration characterized by MRI, X-ray, and histology.Spine. 2004; 30: 15-24
- Does incorrect level needle localization during anterior cervical discectomy and fusion lead to accelerated disc degeneration?.Spine. 2009; 34: 189-192
- Does discography cause accelerated progression of degeneration changes in the lumbar disc—a ten-year matched cohort study.Spine. 2009; 34: 2338-2345
- Provocative discography in patients after limited lumbar discectomy: a controlled, randomized study of pain response in symptomatic and asymptomatic patients.Spine. 2000; 25: 3065-3071
- Prospective controlled study of the development of lower back pain in previously asymptomatic subjects undergoing experimental discography.Spine. 2004; 29: 1112-1117
- Discographic, MRI and psychosocial determinants of low back pain disability and remission: a prospective study in subjects with benign persistent back pain.Spine J. 2005; 5: 24-35
- Lumbar discography in normal subjects. A controlled, prospective study.J Bone Joint Surg Am. 1990; 72: 1081-1088
- Episodes of low back pain: a proposal for uniform definitions to be used in research.Spine. 2002; 27: 2409-2416
- Needle puncture injury of the rat intervertebral disc affects torsional and compressive biomechanics differently.Eur Spine J. 2010; 19: 2110-2116
- The effects of needle puncture injury on microscale shear strain in the intervertebral disc annulus fibrosus.Spine J. 2010; 10: 1098-1105
- ISSLS Prize winner: microstructure and mechanical disruption of the lumbar disc annulus.Spine. 2008; 33: 2711-2720
- Deleterious effects of discography radiocontrast solution on human annulus cell in vitro: changes in cell viability, proliferation, and apoptosis in exposed cells.Spine J. 2012; 12: 329-335
Article info
Publication history
Published online: June 29, 2015
Accepted:
June 16,
2015
Received in revised form:
May 16,
2015
Received:
November 7,
2014
Footnotes
FDA device/drug status: Not applicable.
Author disclosures: JMC: Stock Ownership: Cytonics (400000 shares, 2%); Scientific Advisory Board: Cytonics (nonfinancial, stock options of unknown value). MPS: Research Support (investigator salary, staff/materials): Pfizer (E, paid to the institution), outside the submitted work; Deputy Editor: The Spine Journal (Nonfinancial). RJH: Senior Medical Advisor: Spreemo (C). JAC: Consulting: Pfizer (B), BioClinica (B); Scientific Advisory Board: General Electric (nonfinancial, travel/lodging reimbursement), Halyard Health (nonfinancial, travel/lodging reimbursement). GAB: Nothing to disclose. EJC: Stock Ownership: Intrinsic Orthopedics (0 shares, less than 1%); Other Office: (F, Editor in Chief of The Spine Journal); Fellowship Support: Orthopaedic Education Research Foundation (OREF; E, fellowship training grant to Stanford University, paid directly to institution/employer), AO Foundation (E, fellowship training grant to Stanford University, paid directly to institution/employer).
The disclosure key can be found on the Table of Contents and at www.TheSpineJournalOnline.com.
Identification
Copyright
© 2016 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
