title: Can discoblock replace discography for identifying painful degenerated discs?
abstract: OBJECTIVE
  The aim of the present study was to intra-individually compare provocative discography and discoblock (disc analgesia) of idiopathic degenerated discs (IDD) results to each other, to clinical parameters, and to MRI findings. By this the value of both diagnostic features should be critically reevaluated.
  
  
  METHODS
  31 intervertebral IDD (Pfirrmann III°-IV°) of 26 patients were analyzed for surgery decision making by combined discoblock/discography procedure in an open MRI at 1T. A correlation analysis was performed between the Dallas Discogram Scale, pain discrimination score (PDS: concordant/discordant/no pain), positive discoblock (Numerical Rating Scale [NRS] reduction by ≥ 3, 60 min after intervention), presence of Modic changes or high intensity zones (HIZ), patient sex and age, intervention level, injection pressure and discography endpoint analysis (pain/pressure/anatomic/volume).
  
  
  RESULTS
  Concordant pain could be evoked in 35% of the IDDs whereas discoblock was positive in 64%. Patients' age, sex, Dallas I, Dallas II, and Pfirrmann scores, as well as the presence of HIZ did not correlate to PDS or discoblock results. Discoblock correlated positively to concordant pain. Further positive correlation was found between PDS and intervention level/pressure, between discoblock and Modic changes/discography endpoint as well as between HIZ and discography endpoint.
  
  
  CONCLUSIONS
  We suggest discoblock to be an additional tool for surgery decision making in patients with IDD because it correlates to concordant pain evoked by provocative discography as well as to presence of Modic changes. Additionally, assessment of a release instead of provocation of pain can be of advantage.
authors: Clinic for Orthopaedics, Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany. Michael.putzier@charite.de
authors: Michael
authors: M
authors: Putzier
authors: Florian
authors: F
authors: Streitparth
authors: Tony
authors: T
authors: Hartwig
authors: Carsten F
authors: CF
authors: Perka
authors: Eike K
authors: EK
authors: Hoff
authors: Patrick
authors: P
authors: Strube
mesh_terms: D000328:Adult; D000779:Anesthetics, Local; D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000473:pathology*; D055959:Intervertebral Disc Degeneration / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D017116:Low Back Pain / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement / Q000187:drug effects / Q000379:methods; D018579:Patient Selection; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local
keywords: Degenerative disc disease; Disc analgesia; Discoblock; Discography; Low back pain; Open-field magnetic resonance imaging; Pain measurement