title: Quantitative discomanometry: correlation of intradiscal pressure values to pain reduction in patients with intervertebral disc herniation treated with percutaneous, minimally invasive, image-guided techniques.
abstract: OBJECTIVE
  To illustrate quantitative discomanometry's (QD) diagnostic efficacy and predictive value in discogenic-pain evaluation in a prospective study correlating intradiscal pressure values with pain reduction after percutaneous image-guided technique (i.e., percutaneous decompression, PD).
  
  
  METHODS
  During the last 3 years, 36 patients [21 male and 15 female (mean age 36 ± 5.8 years)] with intervertebral disc hernia underwent QD before PD. Under absolute sterilization and fluoroscopy, a mixture of contrast medium and normal saline (3:1 ratio) was injected. A discmonitor performed a constant rate injection and recorded pressure and volume values, thus producing the relative pressure-volume curve. PD was then performed. Pain reduction and improved mobility were recorded at 3, 12, and 24 months after PD using clinical evaluation and a numeric visual scale (NVS; 0 to 10 units).
  
  
  RESULTS
  Mean pain values of 7.5 ± 1.9 (range 4 to 8) NVS units were recorded before PD; these decreased to 2.9 ± 2.44 at 3 months, 1.0 ± 1.9 at 12 months, and 1.0 ± 1.9 NVS units at 24 months after PD. Recorded correlations (pressure, volume, significant pain-reduction values) with bilateral statistical significance included a maximum injected volume of 2.4 ml (p = 0.045), P (o) < 14 psi [initial pressure required to inject 0.1 ml of the mixture inside the disc (p = 0.05)], P (max) ≤ 65 psi [greatest pressure value on the curve (p = 0.018)], and P (max) - P (o) ≤ 47 psi (p = 0.038). Patients meeting these pressure or volume cut-off points, either independently or as a total, had significant pain reduction (>4 NVS units) after PD. No complications were noted.
  
  
  CONCLUSIONS
  QD is an efficient technique that may have predictive value for discogenic pain evaluation. It might serve as a useful tool for patient selection for intervertebral disc therapies.
authors.affiliation: Second Radiology Department, University General Hospital Attikon, Athens, Greece. dfilippiadis@yahoo.gr
authors.forename: Dimitrios K
authors.initials: DK
authors.lastname: Filippiadis
authors.forename: A
authors.initials: A
authors.lastname: Mazioti
authors.forename: O
authors.initials: O
authors.lastname: Papakonstantinou
authors.forename: E
authors.initials: E
authors.lastname: Brountzos
authors.forename: A
authors.initials: A
authors.lastname: Gouliamos
authors.forename: N
authors.initials: N
authors.lastname: Kelekis
authors.forename: A
authors.initials: A
authors.lastname: Kelekis
mesh_terms: D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D019299:Decompression, Surgical; D017587:Diskectomy, Percutaneous / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000503:physiopathology* / Q000601:surgery*; D008297:Male; D008365:Manometry / Q000379:methods*; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D016896:Treatment Outcome