title: Operative and nonoperative treatment approaches for lumbar degenerative disc disease have similar long-term clinical outcomes among patients with positive discography.
abstract: OBJECTIVE
  It remains unclear whether fusion for lumbar degenerative disc disease with positive discography produces better outcomes compared with nonoperative treatment. The aim of this study was to compare outcomes of patients with discography-concordant lumbar degenerative disc disease electing for fusion versus nonoperative treatment.
  
  
  METHODS
  We retrospectively reviewed consecutive patients with back pain and concordant lumbar discogram who were offered fusion. Follow-up questionnaires included pain score, Oswestry disability index, short form-12, and satisfaction scale. Patients were stratified based on whether they elected for fusion or nonoperative treatment.
  
  
  RESULTS
  Overall follow-up was 48% (96/200). Patients lacking follow-up were slightly older (P = 0.021) and less likely to be smokers (P = 0.013). Between patients with and without follow-up, there were no significant differences in pain score at initial visit, body mass index, or gender (P ≥ 0.40). The 96 patients for whom follow-up was obtained included 53 in the operative and 43 in the nonoperative groups. At baseline, there were no significant differences between these groups based on age, pain score, body mass index, smoking, or gender (P ≥ 0.25). Mean follow-up was 63 months for operative and 58 months for nonoperative patients (P = 0.20). The mean pain score at last follow-up improved significantly for operative and nonoperative patients (P < 0.001). At follow-up, operative and nonoperative groups did not differ significantly with regard to pain scores, Oswestry disability index, short form-12, or satisfaction scale.
  
  
  CONCLUSIONS
  Comparison of long-term outcomes for patients with back pain and concordant discography did not demonstrate a significant difference in outcome measures of pain, health status, satisfaction, or disability based on whether the patient elected for fusion or nonoperative treatment.
authors.affiliation: Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA. Electronic address: jss7f@virginia.edu.
authors.forename: Justin S
authors.initials: JS
authors.lastname: Smith
authors.affiliation: Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
authors.forename: Gursukhman
authors.initials: G
authors.lastname: Sidhu
authors.affiliation: Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
authors.forename: Ken
authors.initials: K
authors.lastname: Bode
authors.affiliation: Department of Orthopedic Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.
authors.forename: David
authors.initials: D
authors.lastname: Gendelberg
authors.affiliation: Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Maltenfort
authors.affiliation: Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: David
authors.initials: D
authors.lastname: Ibrahimi
authors.affiliation: Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Shaffrey
authors.affiliation: Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Vaccaro
mesh_terms: D000328:Adult; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000473:pathology* / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000473:pathology* / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000379:methods*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Degenerative disc disease; Discogram; Discography; Fusion; Lumbar; Outcomes; Spine; Surgery