Open AccessAn Update of the Systematic Appraisal of the Accuracy and Utility of Lumbar Discography in Chronic Low Back Pain
Author(s) -
Laxmaiah Manchikanti,
Ramsin Benyamin,
Vijay Singh,
Frank J E Falco,
Haroon Hameed,
Richard Derby,
Lee R. Wolfer,
Standiford Helm,
Aaron Calodney,
Sukdeb Datta,
Lee T. Snook,
David Caraway,
Joshua A Hirsch,
Steven P. Cohen
Publication year - 2013
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.2013/16/se55
Subject(s) - discography , medicine , provocation test , low back pain , critical appraisal , checklist , back pain , lumbar , physical therapy , systematic review , evidence based medicine , medline , surgery , alternative medicine , pathology , psychology , political science , law , cognitive psychology
Background: The intervertebral disc has been implicated as a major cause of chronic lumbarspinal pain based on clinical, basic science, and epidemiological research. There is, however, alack of consensus regarding the diagnosis and treatment of intervertebral disc disorders. Based oncontrolled evaluations, lumbar intervertebral discs have been shown to be the source of chronicback pain without disc herniation in 26% to 39% of patients. Lumbar provocation discography,which includes disc stimulation and morphological evaluation, is often used to distinguish apainful disc from other potential sources of pain. Despite the extensive literature, intense debatecontinues about lumbar discography as a diagnostic tool.Study Design: A systematic review of the diagnostic accuracy of lumbar provocation andanalgesic discography literature.Objective: To systematically assess and re-evaluate the diagnostic accuracy of lumbar discography.Methods: The available literature on lumbar discography was reviewed. A methodological qualityassessment of included studies was performed using the Quality Appraisal of Reliability Studies(QAREL) checklist. Only diagnostic accuracy studies meeting at least 50% of the designatedinclusion criteria were included in the analysis. However, studies scoring less than 50% arepresented descriptively and critically analyzed.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 September 2012, and manual searches of the bibliographies of known primary andreview articles.Results: Over 160 studies were considered for inclusion. Of these, 33 studies compared discographywith other diagnostic tests, 30 studies assessed the diagnostic accuracy of discography, 22 studiesassessed surgical outcomes for discogenic pain, and 3 studies assessed the prevalence of lumbardiscogenic pain. The quality of the overall evidence supporting provocation discography based onthe above studies appears to be fair. The prevalence of internal disc disruption is estimated to be39% to 42%, whereas the prevalence of discogenic pain without assessing internal disc disruptionis 26%.Conclusion: This systematic review illustrates that lumbar provocation discography performedaccording to the International Association for the Study of Pain (IASP) criteria may be a useful toolfor evaluating chronic lumbar discogenic pain.Key words: Lumbar intervertebral disc, lumbar discography, provocation discography, analgesicdiscography, diagnostic accuracy