Discography Predicts Surgical Outcome

[ampaphb]

[Retrospective and comparative analysis of therapy for degenerative chronic discogenic low back pain with end plate Modic changes with discography and intradiscal injection blockage.]
[Article in Chinese]
Sun CH, Zheng T, Chen Z, Zheng YH, Cao P, Zhang ZW, Lu J, Zou L.
Zhonghua Yi Xue Za Zhi. 2013 Jun;93(23):1806-1810.

Department of Orthopaedics, Rui Jin-Lu Wan Hospital, Shanghai 200020, China.

OBJECTIVE: To evaluate the prognosticating effects of discography and intradiscal injection blockage for patients with degenerative chronic discogenic low back pain and end plate Modic changes when posterior lumbar interbody fusion (PLIF) was adopted.

METHODS: Patients who received diagnostic discography for suspected degenerative discogenic low back pain were recruited. A total of 60 patients (42 males and 18 females) with positive discography and end plate Modic changes at a single level were enrolled in the study and allocated into Groups A and B: Group A was both positive sign of discography and negative sign of intradiscal injection blockage twe weeks later, which further was subdivided into Group A1 (Modic I endplate change) and Group A2 (Modic II endplate change). Group B was both positive sign of discography and intradiscal injection blockage twe weeks later, which further was subdivided into Group A1 (Modic I endplate change) and Group A2 (Modic II endplate change). There were 15 cases in each subgroup, with a mean age of 43.2 years old (29 to 62 years old). The lumbar decompression combined with interbody fusion was performed for these patients. The clinical outcome of each patient was evaluated and recorded by using the VAS and ODI before operation and at 24 months after the procedure. The bone fusion state was evaluated by both dynamic X-ray and CT reconstruction films.

RESULTS: There was no statistical difference of the scales of VAS and ODI before operation.Compared with the scales before operation, although the scales of VAS and ODI of both group A and group B at 24 months after the procedure were significantly improved, the scales of both VAS and ODI of group B were significantly superior to group A. The statistics analysis showed that comparing the improvement rate of VAS and ODI before and after operation, group B was significantly superior to group A, but there was no obviously correlations between the type of Modc endplate change and the the improvement rate of VAS and ODI.

CONCLUSION: The combination the discography with intradiscal injection blockage before operation would effectively prognosticate the therapy of posterior lumbar interbody fusion. There was no obviously correlations between the type of Modc endplate change and the improvement rate of VAS and ODI.

PMID: 24124714

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[Ducttape]

1. small sample size. is it enough?

2. retrospective study.

3. whats the point?

although the scales of VAS and ODI of both group A and group B at 24 months after the procedure were significantly improved

is a surgeon not going to do a PLIF in a patient that has positive disco and negative intradiscal injection blockage, just based on the negative intradiscal injection blockage, if there is significant improvement even with a negative result?

4. a question - does VAS show reproducibility? i believe ODI does, but using VAS as an endpoint may not be valid.

5. discography did not predict surgical outcome. all patients got discography. no placebo, not blinded, no patients who did not get disco, no patients in non-surgical arm, etc.

 

[101N]

I'll make you a bet. In the US, I will bet you that the rate of discography correlates directly with the rate of lumbar fusion. If you live in an area where there is a lot of discography then you also live in an area where there is a lot of fusion. Thus, by advocating for discography you are - perhaps unintentionally - advocating for fusion.

This was the case in the SF bay area in the early 2000s and it's what piqued Carragee's interest in discography.