Clinical relevance of discography combined with CT scanning. A study of 100 patients

Antti-Poĭka, I; Soini, J; Tallroth, Kaj; Yrjönen, Timo; Konttinen, Y T

doi:10.1302/0301-620x.72b3.2140365

“…In our study concordant pain response was reproduced in 50.8% of the discs. Moreover, Antti-Poika et al have reported a 53% positive rate, which is similar to our finding 9 . Accordingly, we consider that disc degeneration and annular rupture may be two important factors related to discogenic pain.…”

Section: Discussionsupporting

confidence: 93%

Analysis of the relationship between morphology of intervertebral disc and some correlated factors following discography in patients with chronic low back pain

Zhang

¹

,

Xiang

²

,

Hu

³

et al. 2009

Orthopaedic Surgery

0

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Objective: To evaluate the diagnostic effectiveness of discography in discogenic low back pain (LBP).Methods: Ninety-six cases of chronic LBP with or without referred thigh pain were enrolled in this study. All these cases received CT scan following discography once conservative treatment for at least 6 months had failed. There were 42 men and 54 women, aged from 24 to 67 years (average 46.4). Discography was performed on 218 discs. The positive discs were classified morphologically according to the Dallas Discogram Description (DDD).Results: (i) The 56 cases (58.3%) which were positive on discography were divided into two subgroups of age less or more than 50 years. Positive rates for the two subgroups were 33.3% and 66.7%, respectively; (ii) one hundred and twenty-two discs, of which 62 (50.8%) were positive on discography, showed morphologic abnormality, whereas all the discography positive discs showed morphologic abnormality. No complication related to discography was found in any case. Conclusion: (i)Compared with the younger patients, older LBP patients have a lower positive rate of discography despite the presence of more serious degenerative disc changes; (ii) outer layer disruption of the annulus fibrous correlates with positive discography; (iii) MRI intensity changes are not specific in diagnosing discogenic pain. Additional discography is needed to identify the painful disc; and (iv) the contrast volume injected into discs can be affected by a variety of factors which restrict its diagnostic value.

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“…It is a subjective test relying on the radiologists' and patients' perceptions to determine the result. [29][30][31][32][33][34][35][36] Many patients with such complaints have associated psychological or psychiatric disturbances which may or may not be associated with medicolegal factors. All of these decrease their ability to give an accurate opinion as to whether the pain produced at discography is that of which they are complaining.…”

Section: Discussionmentioning

confidence: 99%

Intervertebral discs which cause low back pain secrete high levels of proinflammatory mediators

Burke

¹

,

Watson

²

,

McCormack

³

et al. 2002

The Journal of Bone and Joint Surgery. British volume

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H erniated intervertebral disc tissue has been shownto produce a number of proinflammatory mediators and cytokines, but there have been no similar studies using discs from patients with discogenic low back pain.We have compared the levels of production of interleukin-6 (IL-6), interleukin-8 (IL-8) and prostaglandin E 2 (PGE 2 ) in disc tissue from patients undergoing discectomy for sciatica (63) with that from patients undergoing fusion for discogenic low back pain (20) using an enzyme-linked immunoabsorbent assay.There was a statistically significant difference between levels of production of IL-6 and IL-8 in the sciatica and low back pain groups (p < 0.006 and p < 0.003, respectively).The high levels of proinflammatory mediator found in disc tissue from patients undergoing fusion suggest that production of proinflammatory mediators within the nucleus pulposus may be a major factor in the genesis of a painful lumbar disc. [Br] 2002;84-B:196-201. J Bone Joint Surg Received 8 June 2001; Accepted 3 August 2001The pathophysiology of discogenic low back pain is incompletely understood. 1 The changes which occur as a disc degenerates are well documented, but are unhelpful in determining whether a degenerate disc will cause pain.2 It is known that disc tissue from patients undergoing discectomy for sciatica synthesises proinflammatory mediators and cytokines. 3-12 Sequestrated and extruded discs produce higher levels of these mediators than specimens in which the annulus is intact. 5,10,12,13 To date, there have been no studies of the production of inflammatory mediators in disc tissue from patients undergoing operations for discogenic low back pain. It has been shown, however, that degenerate discs in these patients contain more nociceptive nerve endings in the endplates of the disc and in the nucleus pulposus than do degenerate discs which do not cause low back pain. 14, 15 We have therefore compared levels of production of the proinflammatory mediators tumour necrosis factor alpha (TNF␣), interleukin-1beta (IL-1␤), interleukin-6 (IL-6), interleukin-8 (IL-8) and prostaglandin E 2 (PGE 2 ), in disc tissue from patients undergoing discectomy for sciatica with those from patients undergoing fusion for discogenic low back pain. Patients and MethodsWe obtained specimens of intervertebral disc from 63 patients undergoing primary lumbar discectomy for sciatica. Intraoperative assessment of the morphology of the disc herniation revealed 25 in which the annulus was intact (AI), 30 in which a nuclear extrusion was present (EXT) and eight in which the nucleus was sequestrated (SEQ). The mean ages were 42 years in the AI group, 39.5 years in the EXT group and 42 years in the SEQ group. The male: female ratio in the AI, EXT and SEQ groups was 17:8, 20:10 and 6:2, respectively. Three specimens were from the L3/L4 level, 28 from the L4/L5 level and 32 from the L5/ S1 level.We also obtained disc specimens from 20 patients undergoing primary lumbar interbody fusion for discogenic low back pain, which had been confirmed by discograph...

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“…It is a subjective test relying on the radiologists' and patients' perceptions to determine the result. [29][30][31][32][33][34][35][36] Many patients with such complaints have associated psychological or psychiatric disturbances which may or may not be associated with medicolegal factors. All of these decrease their ability to give an accurate opinion as to whether the pain produced at discography is that of which they are complaining.…”

Section: Discussionmentioning

confidence: 99%

Intervertebral discs which cause low back pain secrete high levels of proinflammatory mediators

Burke

¹

,

Watson

²

,

McCormack

³

et al. 2002

The Journal of Bone and Joint Surgery

View full text Add to dashboard Cite

Herniated intervertebral disc tissue has been shown to produce a number of proinflammatory mediators and cytokines, but there have been no similar studies using discs from patients with discogenic low back pain. We have compared the levels of production of interleukin-6 (IL-6), interleukin-8 (IL-8) and prostaglandin E2 (PGE2) in disc tissue from patients undergoing discectomy for sciatica (63) with that from patients undergoing fusion for discogenic low back pain (20) using an enzyme-linked immunoabsorbent assay. There was a statistically significant difference between levels of production of IL-6 and IL-8 in the sciatica and low back pain groups (p < 0.006 and p < 0.003, respectively). The high levels of proinflammatory mediator found in disc tissue from patients undergoing fusion suggest that production of proinflammatory mediators within the nucleus pulposus may be a major factor in the genesis of a painful lumbar disc.

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Clinical relevance of discography combined with CT scanning. A study of 100 patients

Cited by 45 publications

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Analysis of the relationship between morphology of intervertebral disc and some correlated factors following discography in patients with chronic low back pain

Analysis of the relationship between morphology of intervertebral disc and some correlated factors following discography in patients with chronic low back pain

Intervertebral discs which cause low back pain secrete high levels of proinflammatory mediators

Intervertebral discs which cause low back pain secrete high levels of proinflammatory mediators

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