Discography for Preoperative Evaluation of Patients with Chronic Low Back Pain and Its Effect on Clinical Results

Background context: Degeneration of intervertebral discs can sometimes cause chronic pain known as degenerative disc disease (DDD), and this condition is primarily treated conservatively. If this fails, surgery can be considered; these patients are often assessed through medical history, clinical findings, and radiology. In some patients uncertainty prevails, therefore additional examinations might be beneficial. One such examination is provocative discography, but its reliability is disputed. No studies have been performed on the impact of discography on clinical outcome after surgery. Purpose: To determine whether information obtained from discography might affect the clinical outcome of surgical interventions in patients with suspected DDD. Study design: A retrospective outcome study with data 1 and 2 years after surgery for DDD. Patient sample: The patient sample consisted of 99 patients with DDD primarily judged as uncertain or complicated, divided into four subgroups according to the reason for clinical uncertainty, and subsequently examined with discography. Outcome measures: The data were reported using a self-assessment questionnaire with validated outcome variables of pain, function, and quality of life. Methods: To evaluate the results after surgery, the outcome of the uncertain patient groups who underwent discography was compared with a control group of 988 patients who were not examined with discography. Results: The discography group had significantly worse results compared with the control group in 10 of the 12 variables analyzed. However, the results after surgery for two of the four subgroups were similar to the results for the control group. Despite this extended preoperative examination, the patients in the remaining two subgroups had a poorer outcome. Conclusion: Discography may in highly selected cases have a positive effect on outcome in some patients with suspected complicated chronic low back pain due to DDD. Results differ depending on the reason for discography and further research on this is needed.


Wilhelm Gillnäs and Svante Berg

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