Abstract
PDF- 2005;8;187-209Discography as a Diagnostic Test for Spinal Pain: A Systematic and Narrative Review
An Invited Review
Rinoo V. Shah, MD, Clifford R. Everett, MD, Anne Marie McKenzie-Brown, MD, and Nalini Sehgal, MD.
Background: The intervertebral disc has been implicated as an etiology of chronic spine pain based on clinical, basic science, and epidemiological research. Unfortunately, there is no way to determine with absolute certainty whether or not the disc is a spinal pain generator. Recent advances in the neurobiology of pain processing further underscore the possibility that we may never know the source of a patient’s pain. At our current level of understanding, from an empirical standpoint, discography is thought of as the best tool to evaluate disc-related pain. Study Design: A systematic review Objectives: To systematically assess the quality of clinical studies evaluating the diagnostic accuracy of discography with respect to chronic spinal pain. Methods: A systematic review of the literature was performed to assess the diagnostic accuracy of discography with respect to chronic spinal pain. Study inclusion/exclusion criteria were based on the modern practice of discography. Selected studies were then subjected to two rating instruments for diagnostic accuracy studies (AHRQ and QUADAS). Specific data were then culled from these studies and tabulated. Evidence was then classified into five levels: conclusive, strong, moderate, limited, or indeterminate. Results: Evidence is strong for the diagnostic accuracy of discography as an imaging tool. Evidence is also strong for the ability of discography to evoke pain. There is strong evidence supporting the role of discography in identifying that subset of patients with lumbar discogenic pain. There is moderate evidence supporting the role of discography in identifying a subset of patients with cervical discogenic pain. There is limited evidence supporting the role of discography in identifying a subset of patients with thoracic discogenic pain. Conclusion: Discography is a useful imaging and pain evaluation tool in identifying a subset of patients with chronic spinal pain secondary to intervertebral disc disorders. Keywords: Spinal pain, intervertebral disc, discography, pain generator, false-positives, diagnostic accuracy