title: 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.
abstract: 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.
authors: Department of Neurosurgery, University of Wisconsin Medical School, Madison, Wisconsin 53792, USA. Resnick@neurosurg.wisc.edu
authors: Daniel K
authors: DK
authors: Resnick
authors: Tanvir F
authors: TF
authors: Choudhri
authors: Andrew T
authors: AT
authors: Dailey
authors: Michael W
authors: MW
authors: Groff
authors: Larry
authors: L
authors: Khoo
authors: Paul G
authors: PG
authors: Matz
authors: Praveen
authors: P
authors: Mummaneni
authors: William C
authors: WC
authors: Watters
authors: Jeffrey
authors: J
authors: Wang
authors: Beverly C
authors: BC
authors: Walters
authors: Mark N
authors: MN
authors: Hadley
mesh_terms: 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*