Open AccessAn Update of the Appraisal of the Accuracy and Utility of Cervical Discography in Chronic Neck Pain
Author(s) -
Obi Onyewu,
Laxmaiah Manchikanti,
Falco Fj,
Sanjiv Singh,
Stephanie Geffert,
Standiford Helm,
Cohen Sp,
Hirsch Ja
Publication year - 2012
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2012/15/e777
Subject(s) - medicine , discography , neck pain , physical therapy , provocation test , chronic pain , low back pain , critical appraisal , facet joint , back pain , evidence based medicine , medline , radiology , surgery , alternative medicine , pathology , lumbar , political science , law
Background: Chronic neck pain represents a significant public health problem. Despitehigh prevalence rates, there is a lack of consensus regarding the causes or treatments forthis condition. Based on controlled evaluations, the cervical intervertebral discs, facet joints,and atlantoaxial joints have all been implicated as pain generators. Cervical provocationdiscography, which includes disc stimulation and morphological evaluation, is occasionallyused to distinguish a painful disc from other potential sources of pain. Yet in the absence ofvalidation and controlled outcome studies, the procedure remains mired in controversy.Study Design: A systematic review of the diagnostic accuracy of cervical discography.Objective: To systematically evaluate and update the diagnostic accuracy of cervicaldiscography.Methods: The available literature on cervical discography was reviewed. Methodologicalquality assessment of included studies was performed using Quality Appraisal of ReliabilityStudies (QAREL). Only diagnostic accuracy studies meeting at least 50% of the designatedinclusion criteria were utilized for analysis. However, studies scoring less than 50% arepresented descriptively and analyzed critically.The level of evidence was classified as good, fair, and limited or poor based on the quality ofevidence developed by the U.S. Preventive Services Task Force (USPSTF).Data sources included relevant literature identified through searches of PubMed and EMBASEfrom 1966 to June 2012, and manual searches of the bibliographies of known primary andreview articles.Results: A total of 41 manuscripts were considered for accuracy and utility of cervicaldiscography in chronic neck pain. There were 23 studies evaluating accuracy of discography.There were 3 studies meeting inclusion criteria for assessing the accuracy and prevalence ofdiscography, with a prevalence of 16% to 53%.Based on modified Agency for Healthcare Research and Quality (AHRQ) accuracy evaluationand United States Preventive Services Task Force (USPSTF) level of evidence criteria, thissystematic review indicates the strength of evidence is limited for the diagnostic accuracy ofcervical discography.Limitations: Limitations include a paucity of literature, poor methodological quality, andvery few studies performed utilizing International Association for the Study of Pain (IASP)criteria.Conclusion: There is limited evidence for the diagnostic accuracy of cervical discography.Nevertheless, in the absence of any other means to establish a relationship between pathologyand symptoms, cervical provocation discography may be an important evaluation tool in certaincontexts to identify a subset of patients with chronic neck pain secondary to intervertebral discdisorders.