1. 2012;15;E757-E776An Update of the Appraisal of the Accuracy of Thoracic Discography as a Diagnostic Test for Chronic Spinal Pain
   Systematic Review
   Allan T. Parr, MD, Stephanie Geffert, MLIS, Laxmaiah Manchikanti, MD, Obi Onyewu, MD, Ramsin M. Benyamin, MD, Sukdeb Datta, MD, Vijay Singh, MD, and Frank J.E. Falco, MD.

BACKGROUND:  Even though the prevalence of thoracic pain has been reported to be 13% of the general population and up to 22% of the population in interventional pain management settings, the role of thoracic discs as a cause of chronic thoracic and extrathoracic pain has not been well studied. The intervertebral discs, zygapophysial or facet joints, and other structures including the costovertebral and costotransverse joints have been identified as a source of thoracic pain.

STUDY DESIGN:  A systematic review of provocation thoracic discography.

OBJECTIVE: To systematically assess and update the quality of clinical studies evaluating the diagnostic accuracy of provocation thoracic discography.

METHODS:  A systematic review of the literature was performed to assess the diagnostic accuracy of thoracic discography with respect to chronic, function limiting, thoracic or extrathoracic pain.

The available literature on thoracic discography was reviewed. A methodological quality assessment of included studies was performed using Quality Appraisal of Reliability Studies (QAREL).

The level of evidence was classified as good, fair, and limited (or poor) based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF).

Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to June 2012, and manual searches of the bibliographies of known primary and review articles.

RESULTS:  The evidence and clinical value of thoracic provocation discography is limited (poor) with a paucity of evidence, with only 2 studies meeting inclusion criteria.

LIMITATIONS: The limitation of this study continues to be the paucity of literature.

CONCLUSION: Based on the available evidence for this systematic review, due to limited evidence, thoracic provocation discography is rarely recommended for the diagnosis of discogenic pain in the thoracic spine, if conservative management has failed and facet joint pain has been excluded.