PMID- 19461822
OWN - NLM
STAT- MEDLINE
DCOM- 20090908
LR  - 20181201
IS  - 2150-1149 (Electronic)
IS  - 1533-3159 (Linking)
VI  - 12
IP  - 3
DP  - 2009 May-Jun
TI  - Systematic review of lumbar discography as a diagnostic test for chronic low back 
      pain.
PG  - 541-59
AB  - 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.
FAU - Manchikanti, Laxmaiah
AU  - Manchikanti L
AD  - Pain Management Center of Paducah, Paducah, KY, USA. drlm@thepainmd.com
FAU - Glaser, Scott E
AU  - Glaser SE
FAU - Wolfer, Lee
AU  - Wolfer L
FAU - Derby, Richard
AU  - Derby R
FAU - Cohen, Steven P
AU  - Cohen SP
LA  - eng
PT  - Journal Article
PT  - Review
PT  - Systematic Review
PL  - United States
TA  - Pain Physician
JT  - Pain physician
JID - 100954394
SB  - IM
MH  - Arthrography/methods
MH  - Diagnostic Imaging/methods
MH  - Humans
MH  - Injections, Intra-Articular/methods
MH  - Injections, Spinal/methods
MH  - Intervertebral Disc/*diagnostic imaging/innervation/physiopathology
MH  - Low Back Pain/*diagnosis/*etiology/physiopathology
MH  - Lumbar Vertebrae/*diagnostic imaging/innervation/physiopathology
MH  - Pain Measurement/*methods
MH  - Predictive Value of Tests
MH  - Sensitivity and Specificity
RF  - 157
EDAT- 2009/05/23 09:00
MHDA- 2009/09/09 06:00
CRDT- 2009/05/23 09:00
PHST- 2009/05/23 09:00 [entrez]
PHST- 2009/05/23 09:00 [pubmed]
PHST- 2009/09/09 06:00 [medline]
PST - ppublish
SO  - Pain Physician. 2009 May-Jun;12(3):541-59.