A critical evaluation of discography in patients with lumbar intervertebral disc disease.
METHODS
The study is a prospective observational study of 48 continuous patients with symptomatic lumbar degenerative disk disease. Each patient underwent discography, MRI, and a biochemical analysis of disk lavage fluid.


OBJECTIVE
The purpose of this study was to correlate concordant pain on discography with MRI grade and biochemical markers of inflammation in a clinical setting.


BACKGROUND
The pathophysiology of degenerative disk disease is complex. Discography is used to differentiate symptomatic from asymptomatic levels. MRI is used to image changes in disk water content. Biochemical assays have identified molecular markers of inflammation. To date, no study has correlated concordant pain on discography with MRI findings and biochemical markers.


METHODS
Forty-eight (48) continuous patients with symptomatic lumbar degenerative disk disease gave informed consent for study entry. Patient sex, age, insurance, work status and visual analog score (VAS) were recorded. MRI was obtained and Pfirrmann grading was performed by a single spine surgeon. Discography with disc lavage was performed by a single anesthesiologist. Lavage samples were tested for inflammatory markers with high resolution multi-plex bead immunoassays and ELISA with >5 pg/ml resolution.


RESULTS
None of demographic variables was significantly related to concordant pain on discogram by chi-squared tests and Mann-Whitney U-test. The Pfirrmann score was significantly different for patients with and without concordant pain at L3-L4 (p<0.001), but was insignificant at other levels after multitest correction. Pfirrmann scores were significantly different at any level in patients with and without concordant pain. VAS scores were not significantly correlated with opening pressures at any level. Despite the presence of serum proteins in the disk lavage fluid, none of the tested inflammatory mediators was identified by multi-plex bead immunoassays and ELISA.


CONCLUSIONS
There are only weak correlations between demographic, discogram, and radiographic variables. Response to discogram cannot be predicted by non-invasive means. The disk lavage method was unable to identify the presence of specific inflammatory peptides with multi-plex immunoassays and ELISA.
Scuderi
Gaetano J
GJ
Private Practice, 2055 Military Trail #204, Jupiter, FL 33458, USA.
Brusovanik
Georgiy V
GV
Golish
S Raymond
SR
Demeo
Ronald
R
Hyde
Jonathan
J
Hallab
Nadim
N
Vaccaro
Alexander R
AR
D000328:Adult; D000368:Aged; D001416:Back Pain / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D015415:Biomarkers / Q000032:analysis; D001798:Blood Proteins / Q000032:analysis; D001826:Body Fluids / Q000737:chemistry; D015180:Electrophoresis, Gel, Two-Dimensional; D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000000981:diagnostic imaging*; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D011859:Radiography; D007507:Therapeutic Irrigation / Q000379:methods
D015415:Biomarkers; D001798:Blood Proteins