title: Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 6: discography for patient selection.
abstract: Identifying the etiology of pain for patients suffering from chronic low-back pain remains problematic. Noninvasive imaging modalities, used in isolation, have not consistently provided sufficient evidence to support performance of a lumbar fusion. Provocative testing has been used as an adjunct in this assessment, either alone or in combination with other modalities, to enhance the diagnostic capabilities when evaluating patients with low-back pain. There have been a limited number of studies investigating this topic since the publication of the original guidelines. Based primarily on retrospective studies, discography, as a stand-alone test, is not recommended to formulate treatment strategies for patients with low-back pain. A single randomized cohort study demonstrated an improved potential of discoblock over discography as a predictor of success following lumbar fusion. It is therefore recommended that discoblock be considered as a diagnostic option. There is a possibility, based on a matched cohort study, that an association exists between progression of degenerative disc disease and the performance of a provocative discogram. It is therefore recommended that patients be counseled regarding this potential development prior to undergoing discography.
authors: Center for Sports Medicine and Orthopaedics, Chattanooga, Tennessee;
authors: Jason C
authors: JC
authors: Eck
authors: Alok
authors: A
authors: Sharan
authors: Daniel K
authors: DK
authors: Resnick
authors: William C
authors: WC
authors: Watters
authors: Zoher
authors: Z
authors: Ghogawala
authors: Andrew T
authors: AT
authors: Dailey
authors: Praveen V
authors: PV
authors: Mummaneni
authors: Michael W
authors: MW
authors: Groff
authors: Jeffrey C
authors: JC
authors: Wang
authors: Tanvir F
authors: TF
authors: Choudhri
authors: Sanjay S
authors: SS
authors: Dhall
authors: Michael G
authors: MG
authors: Kaiser
mesh_terms: D019317:Evidence-Based Medicine; D006801:Humans; D007403:Intervertebral Disc / Q000473:pathology / Q000601:surgery; D017116:Low Back Pain / Q000473:pathology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000592:standards*; D010147:Pain Measurement; D010347:Patient Care Planning; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D013122:Spinal Diseases / Q000473:pathology* / Q000601:surgery*; D013123:Spinal Fusion / Q000592:standards*
keywords: AAOS = American Academy of Orthopaedic Surgeons; JOA = Japanese Orthopaedic Association; MODEMS = Musculoskeletal Outcomes Data Evaluation and Management System; ODI = Oswestry Disability Index; VAS = visual analog scale; discoblock; discography; fusion; lumbar spine; practice guidelines