The rates of false-positive lumbar discography in select patients without low back symptoms.
METHODS
Experimental disc injections in subjects with no history of low back symptoms.


OBJECTIVE
To determine in an experimental setting the relative pain response and pain-related behavior in selected subjects without a history of low back pain undergoing lumbar discography. This study aimed to select a study population that more closely represented patients undergoing discography in clinical practice.


BACKGROUND
Previous work has shown that in young, healthy men with little degenerative disc disease and no history of low back problems, discographic injections usually did not cause significant pain. This group differed from the patients who usually undergo discographic evaluation in clinical practice. Most clinical patients are older, have significant degenerative disc disease, have behavioral changes associated with chronic pain, and often have confounding psychosocial troubles. The authors undertook to study discography in subjects without low back pain but with clinical profiles similar to patients undergoing discography in clinical practice.


METHODS
Twenty-six individuals, mean age 43 years, with no history of low back pain had lumber discography according to the strict protocol of Walsh et al. Of these, 10 were pain-free; 10 had chronic neck and arm pain, but no low back symptoms; and 6 had primary somatization disorders without low back symptoms.-


RESULTS
Significant positive pain response and pain-related behavior with discography were found in 10% of the pain-free group, in 40% of the chronic cervical pain group, and in 83% of the somatization disorder group completing the injections. Twenty-four subjects had negative control discs. Discs with annular disruption were more likely to be painful on injection, particularly in those individuals with ongoing compensation issues, chronic pain, or abnormal psychological testing.-


CONCLUSIONS
If strict criteria are applied, the rate of false-positive discography may be low in subjects with normal psychometric profiles and without chronic pain. Significantly painful injections were very common in subjects with annular disruption and chronic pain or abnormal psychometric testing.
Carragee
E J
EJ
Department of Orthopedic Surgery, Stanford University School of Medicine, California 94305, USA. carragee@leland.stanford.edu
Tanner
C M
CM
Khurana
S
S
Hayward
C
C
Welsh
J
J
Date
E
E
Truong
T
T
Rossi
M
M
Hagle
C
C
D000328:Adult; D002908:Chronic Disease; D015331:Cohort Studies; D004185:Disability Evaluation; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000000981:diagnostic imaging*; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging* / Q000523:psychology / Q000534:rehabilitation; D017116:Low Back Pain / Q000000981:diagnostic imaging* / Q000523:psychology / Q000534:rehabilitation; D008159:Lumbar Vertebrae; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011594:Psychometrics; D011859:Radiography; D012803:Sick Role; D014942:Workers' Compensation