Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 6: magnetic resonance imaging and discography for patient selection for lumbar fusion.
Discography is an exquisitely sensitive but not specific diagnostic test for the diagnosis of discogenic low-back pain. The restriction of the definition of a positive discographic study to one that elicits concordant pain from a morphologically abnormal disc improves the definition's accuracy. Fusion surgery based on discography alone, however, is not reliably associated with clinical success. Therefore, discography is not recommended as a standalone test for treatment decisions in patients with low-back pain. Magnetic resonance imaging is a sensitive and noninvasive test for the presence of degenerative disc disease. Discography should not be attempted in patients with normal lumbar MR images. Discography appears to have a role in the evaluation of patients with low-back pain, but it is best limited to the evaluation of abnormal interspaces identified on MR imaging, the investigation of adjacent-level disc disease, and as a means to rule out cases of nonorganic pain from surgical consideration.
Resnick
Daniel K
DK
Department of Neurosurgery, University of Wisconsin Medical School, Madison, Wisconsin 53792, USA. Resnick@neurosurg.wisc.edu
Choudhri
Tanvir F
TF
Dailey
Andrew T
AT
Groff
Michael W
MW
Khoo
Larry
L
Matz
Paul G
PG
Mummaneni
Praveen
P
Watters
William C
WC
Wang
Jeffrey
J
Walters
Beverly C
BC
Hadley
Mark N
MN
D006801:Humans; D007403:Intervertebral Disc / Q000473:pathology / Q000601:surgery; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000592:standards*; D018579:Patient Selection; D013122:Spinal Diseases / Q000473:pathology* / Q000601:surgery*; D013123:Spinal Fusion / Q000592:standards*