title: No Transfer of Pressure to Adjacent Discs During Human Low-Pressure Controlled Discography: A Prospective Clinical Study.
abstract: A substantial part of low back pain (LBP) originates from degeneration of the intervertebral disc. To confirm the diagnosis of discogenic pain, provocation discography seems the best available tool. However, provocation discography is also considered to be a controversial and subjective test because the patient's personal pain response is the most crucial for the result of the test. Recently, an in vivo porcine study and a study in nine human subjects showed passing of pressure to the adjacent discs during discography. This could mean that the concordant pain the patient describes originates from an adjacent disc. The object of this study is to assess if during human lumbar pressure-controlled provocation discography there is pressure transmission to adjacent discs.
  
  
  
  Consecutive patients between age 18 and 65 years with intractable low back pain and at least 50% preserved height of the suspected painful disc were included. Exclusion criteria were prior lumbar surgery of the suspected level, use of anticoagulants, pregnancy, local infection, and iodine allergy. An arterial blood pressure monitoring system simultaneously assessed the pressure in the adjacent discs while low-speed flow, pressure-controlled discography was performed.
  
  
  
  In 50 patients with a positive discography, the average intradiscal peak pressure was 15.1 psi (SD = 11.1). In 48 procedures, no pressure rise in the adjacent discs was found. A small pressure rise (1.1 psi) in the adjacent disc during discography was recorded in two patients.
  
  
  
  Pressure rise in adjacent discs does not seem to occur during low-speed flow pressure-controlled lumbar provocation discography. False-positive pain reactions caused by potentially painful adjacent discs are therefore unlikely during pressure-controlled discography.
authors.affiliation: Department of Anaesthesiology and Pain Management Arnhem, Rijnstate Hospital, Arnhem, the Netherlands.
authors.forename: Jan Willem
authors.initials: JW
authors.lastname: Kallewaard
authors.affiliation: Department of Anaesthesiology and Pain Management Arnhem, Rijnstate Hospital, Arnhem, the Netherlands.|Departments of Anaesthesiology and Pain Medicine Maastricht.
authors.forename: José W
authors.initials: JW
authors.lastname: Geurts
authors.affiliation: Department of Anaesthesiology and Pain Management Arnhem, Rijnstate Hospital, Arnhem, the Netherlands.
authors.forename: Michel
authors.initials: M
authors.lastname: Terheggen
authors.affiliation: Department of Anaesthesiology and Pain Management Arnhem, Rijnstate Hospital, Arnhem, the Netherlands.
authors.forename: Chris
authors.initials: C
authors.lastname: Terwiel
authors.affiliation: Clinical Epidemiology and Medical Technology.
authors.forename: Alfons
authors.initials: A
authors.lastname: Kessels
authors.affiliation: Departments of Anaesthesiology and Pain Medicine Maastricht.
authors.forename: Maarten
authors.initials: M
authors.lastname: van Kleef
authors.affiliation: Orthopaedic Surgery Maastricht, Maastricht University Medical Centre, Maastricht, the Netherlands.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Willems
mesh_terms: D000328:Adult; D019937:Diagnostic Techniques and Procedures; D005260:Female; D006801:Humans; D007403:Intervertebral Disc; D017116:Low Back Pain / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011312:Pressure; D055815:Young Adult
keywords: Diagnostic Tests; Discography; Humans; Intervertebral Disc; Low Back Pain; Pressure