title: Automated Pressure-Controlled Discography in Patients Undergoing Anterior Lumbar Interbody Fusion for Discogenic Back Pain.
abstract: METHODS
  Retrospective cohort study.
  
  
  OBJECTIVE
  To compare the clinical outcomes of patients undergoing anterior lumbar interbody fusion (ALIF) with or without automated pressure-controlled discography (APCD) before the procedure.
  
  
  METHODS
  Patients (n = 36) who underwent ALIF for lumbar discogenic back pain between 2008 and 2013 and were followed for more than 6 months were enrolled in this study. APCD was performed to identify discogenic back pain. Preoperative x-rays, computed tomography images, and magnetic resonance images were obtained. The intervertebral disc height, type of Modic change, grade of disc degeneration, and fusion rate were determined. Additionally, the presence or absence of high-intensity zone and vacuum disc were checked preoperatively. Clinical evaluation was performed by visual analog scale (0 = no pain, 10 = worst pain imaginable), Oswestry Disability Index (ODI), and 36-Item Short Form Health Survey before surgery and every 6 months postoperatively.
  
  
  RESULTS
  The average patient age was 53.3 years (range, 31-73 years). The mean follow-up durations were 19.7 months. Seventeen patients (the APCD-ALIF group) underwent ALIF after APCD, and 19 patients underwent ALIF without APCD. The APCD-ALIF group had significantly improved clinical outcomes compared with the control group (visual analog scale score 1.8 ± 1.6 vs. 3.3 ± 2.4; P = 0.039: ODI score 6.7 ± 6.3 vs. 12.1 ± 6.8; P = 0.019). The surgical improvement rate was significantly associated with ODI score (P = 0.005).
  
  
  CONCLUSIONS
  The results of this study confirm that APCD aids surgical outcomes of ALIF in patients with suspected lumbar discogenic pain. We recommend performing APCD before ALIF to confirm lumbar discogenic pain.
authors.affiliation: Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea; Department of Neurosurgery, Keimyung University Dongsan Medical Center, Daegu, Korea.
authors.forename: Chang Kyu
authors.initials: CK
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea; Department of Medical System Engineering, Gwangju Institute of Science and Technology, Gwangju, Korea. Electronic address: cistern@yuhs.ac.
authors.forename: Dong Ah
authors.initials: DA
authors.lastname: Shin
authors.affiliation: Department of Medical System Engineering, Gwangju Institute of Science and Technology, Gwangju, Korea.
authors.forename: Hyoung Ihl
authors.initials: HI
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Seong
authors.initials: S
authors.lastname: Yi
authors.affiliation: Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Yoon
authors.initials: Y
authors.lastname: Ha
authors.affiliation: Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Keung Nyun
authors.initials: KN
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Do Heum
authors.initials: DH
authors.lastname: Yoon
mesh_terms: D000328:Adult; D000368:Aged; D001416:Back Pain / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000150:complications / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011312:Pressure; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013123:Spinal Fusion / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D064232:Visual Analog Scale
keywords: Anterior lumbar interbody fusion; Automated pressure-controlled discography; Discogenic back pain; Discogram; Discography