title: Factors influencing manometric pressure during pressure-controlled discography.
abstract: METHODS
  In vitro laboratory study.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the effects of injection speed, contrast viscosity, and needle profile on manometric pressures during discography.
  
  
  BACKGROUND
  As the degree of the response in a provocation test depends on the intensity of the stimulus, the precise measurement of intradiscal pressure during discography is crucial. Although manometric pressure measurement is safe and easy, manometric pressures may be affected by potential confounding factors, including injection speed, contrast viscosity, and needle profile.
  
  
  METHODS
  Pressure-controlled discography was performed using an automated pressure-controlled discography system in a total of 60 intervertebral discs in 2 porcine cadavers. Dynamic pressures were measured while changing the following parameters: injection speed (0.01 mL/s vs. 0.08 mL/s), media viscosity (Visipaque vs. normal saline), needle diameter (18G vs. 22G), and needle length (7 inch vs. 3.5 inch). The unit change in manometric pressure per fractional change in injected volume (dP/dV) was used for statistical analysis.
  
  
  RESULTS
  The mean dP/dV increased from 137.9 +/- 11.3 at 0.08 mL/s to 160.3 +/- 12.5 at 0.01 mL/s. Visipaque injection resulted in a higher mean dP/dV than the normal saline injection (160.3 +/- 12.5 vs. 97.8 +/- 34.1). A 7.5 inch needle had a higher mean dP/dV than a 3.5 inch needle (137.9 +/- 11.3 vs. 92.5 +/- 48.6). The mean dP/dV of the 22G needle was higher than the 18G needle (137.9 +/- 11.3 vs. 84.7 +/- 28.3).
  
  
  CONCLUSIONS
  High injection speed, high viscosity, small diameter, and a long needle increase the dynamic pressure. To minimize the differences among examiners, we recommend standardization of injection speed, the viscosity of the injected material, and the diameter and length of the needle.
authors.affiliation: CHA University College of Medicine, Seoul, Korea.
authors.forename: Dong Ah
authors.initials: DA
authors.lastname: Shin
authors.forename: Sang Hyun
authors.initials: SH
authors.lastname: Kim
authors.forename: In Bo
authors.initials: IB
authors.lastname: Han
authors.forename: Seung Chul
authors.initials: SC
authors.lastname: Rhim
authors.forename: Hyoung Ihl
authors.initials: HI
authors.lastname: Kim
mesh_terms: D000818:Animals; D001696:Biomechanical Phenomena / Q000502:physiology; D004396:Coloring Agents; D019245:Compressive Strength / Q000502:physiology; D003287:Contrast Media; D004548:Elasticity / Q000502:physiology; D004867:Equipment Design; D051445:Fibrocartilage / Q000473:pathology / Q000503:physiopathology; D007278:Injections, Spinal / Q000295:instrumentation / Q000379:methods; D007403:Intervertebral Disc / Q000473:pathology / Q000503:physiopathology*; D007405:Intervertebral Disc Displacement / Q000175:diagnosis* / Q000503:physiopathology*; D008365:Manometry / Q000379:methods; D009339:Needles; D010147:Pain Measurement / Q000379:methods*; D011237:Predictive Value of Tests; D011312:Pressure / Q000009:adverse effects*; D012680:Sensitivity and Specificity; D034421:Sus scrofa; D014160:Transducers, Pressure; D016474:Weight-Bearing / Q000502:physiology
chemical_list: D004396:Coloring Agents; D003287:Contrast Media