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Richard Derby - One of the best experts on this subject based on the ideXlab platform.
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Toward more useful pressure-controlled discography: in vitro evaluation of injection speed, sensor location, and tube length.
Pain Medicine, 2010Co-Authors: Woo Sung Choi, Shin Da, Richard DerbyAbstract:Objective. Pressure-controlled manometric discography is used by clinicians to evaluate discogenic pain. However, some would improve diagnostic accuracy. The goal of this study was to investigate potential confounding factors that might affect discographic results. Pressure differences depending on different speed of injection, lengths of connecting tubing and locations of sensors were evaluated using an in vitro model system. Methods. Two sets of automated discography devices were arranged to record post-syringeal pressure pressures (PSPs) and intradiscal pressures (IDPs) in an “air chamber disk model” representing intradiscal pressure. PSPs and IDPs were measured simultaneously while varying injection speeds, and using intrasyringeal and extrasyringeal pressure sensors and contrast medium-filled tubing of different lengths. All pressure/volume curves were collected and viewed dynamically, and stored for further analysis. Results. At injection speed of 0.1 cc/second, the mean pressure difference (mean Δ P ) between PSP and IDP was 38.1 psi. As injection speed was reduced, mean Δ P was proportionally decreased. Mean Δ P was 5.3 psi at injection speed of 0.01 cc/second and 0.7 psi at 0.005 cc/second. Mean Δ P values were significantly higher when pressures were recorded using intrasyringeal sensor: at injection speed of 0.1 cc/second, PSP and IDP values were 82.9 and 30.1 psi, respectively, compared with 50.6 and 12.5 psi measured by extrasyringeal sensor. Mean Δ P due to increased length of tubing was not significant. Conclusion. Discography can be better performed with low speed injection (≤0.01 cc/second), using an extrasyringeal sensor. Difference of length of connecting tubings did not cause significant pressure differences. These data suggest that automated discography is a helpful adjunct to improve diagnostic accuracy, due to extrasyringeal location of pressure sensor and greater control of injection speed.
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Can magnetic resonance imaging accurately predict concordant pain provocation during provocative disc injection?
Skeletal Radiology, 2009Co-Authors: Chang Ho Kang, Richard Derby, Sang Heon Lee, Yun Hwan Kim, Jung Hyuk Kim, Kyoo Byung Chung, Deuk Jae SungAbstract:Objective To correlate magnetic resonance (MR) image findings with pain response by provocation discography in patients with discogenic low back pain, with an emphasis on the combination analysis of a high intensity zone (HIZ) and disc contour abnormalities. Materials and methods Sixty-two patients (aged 17–68 years) with axial low back pain that was likely to be disc related underwent lumbar discography (178 discs tested). The MR images were evaluated for disc degeneration, disc contour abnormalities, HIZ, and endplate abnormalities. Based on the combination of an HIZ and disc contour abnormalities, four classes were determined: (1) normal or bulging disc without HIZ; (2) normal or bulging disc with HIZ; (3) disc protrusion without HIZ; (4) disc protrusion with HIZ. These MR image findings and a new combined MR classification were analyzed in the base of concordant pain determined by discography. Results Disc protrusion with HIZ [sensitivity 45.5%; specificity 97.8%; positive predictive value (PPV), 87.0%] correlated significantly with concordant pain provocation ( P
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can magnetic resonance imaging accurately predict concordant pain provocation during provocative disc injection
Skeletal Radiology, 2009Co-Authors: Chang Ho Kang, Richard Derby, Sang Heon Lee, Yun Hwan Kim, Jung Hyuk Kim, Kyoo Byung Chung, Deuk Jae SungAbstract:To correlate magnetic resonance (MR) image findings with pain response by provocation discography in patients with discogenic low back pain, with an emphasis on the combination analysis of a high intensity zone (HIZ) and disc contour abnormalities. Sixty-two patients (aged 17–68 years) with axial low back pain that was likely to be disc related underwent lumbar discography (178 discs tested). The MR images were evaluated for disc degeneration, disc contour abnormalities, HIZ, and endplate abnormalities. Based on the combination of an HIZ and disc contour abnormalities, four classes were determined: (1) normal or bulging disc without HIZ; (2) normal or bulging disc with HIZ; (3) disc protrusion without HIZ; (4) disc protrusion with HIZ. These MR image findings and a new combined MR classification were analyzed in the base of concordant pain determined by discography. Disc protrusion with HIZ [sensitivity 45.5%; specificity 97.8%; positive predictive value (PPV), 87.0%] correlated significantly with concordant pain provocation (P < 0.01). A normal or bulging disc with HIZ was not associated with reproduction of pain. Disc degeneration (sensitivity 95.4%; specificity 38.8%; PPV 33.9%), disc protrusion (sensitivity 68.2%; specificity 80.6%; PPV 53.6%), and HIZ (sensitivity 56.8%; specificity 83.6%; PPV 53.2%) were not helpful in the identification of a disc with concordant pain. The proposed MR classification is useful to predict a disc with concordant pain. Disc protrusion with HIZ on MR imaging predicted positive discography in patients with discogenic low back pain.
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Are outer annular fissures stimulated during Diskography the source of diskogenic low-back pain? An analysis of analgesic Diskography data.
Pain medicine (Malden Mass.), 2009Co-Authors: Michael J Depalma, Jeong-eun Lee, Lane Peterson, Lee R. Wolfer, Jessica Ketcum, Richard DerbyAbstract:Objective. This study aimed to clarify whether painful annular fissures stimulated during provocation Diskography are the likely source of diskogenic pain. Design. A retrospective analysis was conducted of prospectively collected data. Setting. Multidisciplinary, academic spine center. Patients. The study was completed in a cohort of 28 consecutive patients were enrolled presenting with 6 months duration of axial low-back pain recalcitrant to physical therapy, oral analgesics, and epidural steroid injections and who have diskogenic pain based on history, exam, magnetic resonance imaging, and Diskography. Interventions. Subjects underwent provocation Diskography and analgesic Diskography utilizing a balloon-tipped intradiskal catheter allowing intradiskal injection of anesthetic. Outcome Measures. Visual analog scale, finger-to-floor distance were utilized as outcome measures. Results. 80% of painful intervertebral disks as detected by provocation Diskography were sufficiently anesthetized resulting in >50% reduction in low-back pain during analgesic Diskography. Conclusion. Diskogenic pain is in varying degrees caused by the sensitized nociocepters within annular tears.
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systematic review of lumbar provocation discography in asymptomatic subjects with a meta analysis of false positive rates
Pain Physician, 2008Co-Authors: Lee R. Wolfer, Richard Derby, Jeong-eun Lee, Sang Heon LeeAbstract:Background Lumbar provocation discography is a controversial diagnostic test. Currently, there is a concern that the test has an unacceptably high false-positive rate. Study design Systematic review and meta-analysis. Objective To perform a systematic review of lumbar discography studies in asymptomatic subjects and discs with a meta-analysis of the specificity and false-positive rate of lumbar discography. Methods A systematic review of the literature was conducted via a PUBMED search. Studies were included/excluded according to modern discography practices. Study quality was scored using the Agency for Healthcare Research and Quality (AHRQ) instrument for diagnostic accuracy. Specific data was extracted from studies and tabulated per published criteria and standards to determine the false-positive rates. A meta-analysis of specificity was performed. Strength of evidence was rated according to the AHRQ U.S. Preventive Services Task Force (USPSTF) criteria. Results Eleven studies were identified. Combining all extractable data, a false-positive rate of 9.3% per patient and 6.0% per disc is obtained. Data pooled from asymptomatic subjects without low back pain or confounding factors, shows a false-positive rate of 3.0% per patient and 2.1% per disc. In data pooled from chronic pain patients, asymptomatic of low back pain, the false-positive rate is 5.6% per patient and 3.85% per disc. Chronic pain does not appear to be a confounding factor in a chronic low back pain patient's ability to distinguish between positive (pathologic) and negative (non-pathologic) discs. Among additional asymptomatic patient subgroups analyzed, the false-positive rate per patient and per disc is as follows: iliac crest pain 12.5% and 7.1%; chronic neck pain 0%; somatization disorder 50% and 22.2%, and, post-discectomy 15% and 9.1%, respectively. In patients with chronic backache, no false-positive rate can be calculated. Low-pressure positive criteria ( Conclusions Strength of evidence is level II-2 based on the Agency for Healthcare Research Quality (USPSTF) for the diagnostic accuracy of discography. Contrary to recently published studies, discography has a low false-positive rate for the diagnosis of discogenic pain.
Charles Aprill - One of the best experts on this subject based on the ideXlab platform.
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Lumbar diskogenic pain, provocation Diskography, and imaging correlates.
Radiologic clinics of North America, 2012Co-Authors: Timothy P. Maus, Charles AprillAbstract:Diskogenic pain refers to pain mediated by the intrinsic innervation of the intervertebral disk. It is experienced as pain centered at the symptomatic spine segment (axial pain) without radicular features or radiculopathy. There is no pathoanatomic gold standard; histologic examination cannot identify a painful disk. The current reference standard for diskogenic pain is provocation Diskography. This article reviews diskogenic pain, the history of provocation Diskography, and its current use in the diagnosis of lumbar diskogenic pain. The extensive literature describing imaging features which may predict a positive diskogram, and allow non-invasive diagnosis of diskogenic pain, is examined.
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Comparison of discographic findings in asymptomatic subject discs and the negative discs of chronic LBP patients: can discography distinguish asymptomatic discs among morphologically abnormal discs?
The spine journal : official journal of the North American Spine Society, 2005Co-Authors: Richard Derby, Sang Heon Lee, Yung Chen, Byung Jo Kim, Kwan Sik Seo, Charles AprillAbstract:Abstract Background context Lumbar discography has been widely used for evaluating discogenic low back pain (LBP). Comparison of pain responses from suspected symptomatic discs with pain responses from asymptomatic negative discs is routine. However, the ability of discography to distinguish asymptomatic morphologically abnormal discs from those that are symptomatic has been understudied. In addition, the discographic characteristics of negative discs in patients with chronic discogenic LBP have not been reported. Criteria for negative morphologically abnormal discs may be valuable for excluding discs from further treatment and examination. Purpose To determine if discography can distinguish asymptomatic discs among morphologically abnormal discs in patients with suspected chronic discogenic LBP and establish the standard characteristics of negative discs. Study design/setting Prospective, experimental with control group. Patient sample Fifty-five discs from a control group of 16 healthy volunteers without current back pain (11 men, 5 women, 32–61 years of age, mean age: 47 years) and 282 discs from a patient group of 90 LBP patients (59 men, 31 women, 20–70 years of age, mean age: 44.7 years) were recruited. Methods Discography was performed using a pressure-controlled manometric technique with an injection rate of 0.05 mL/s and a 3.5 mL restricted total volume. Concordance was rated as none/unfamiliar, or familiar. Pain was rated via a 0–10 numerical rating scale (NRS). The pressure and volume at which pain was evoked and NRS pain responses at 15, 30, and 50 psi were recorded. Annular disruption grade was rated during the procedure by computed tomography discography and fluoroscopic imaging. Negative discogram required no pain described by the participant as “familiar,” with no pain responses ≥6/10 NRS at pressures ≤50 psi above opening pressure and ≤3.5 mL total injected volume. Patient discs were partitioned into two subgroups based on discographic findings: Neg-D (negative discs) and Pos-D (positive discs). Only discs with Grade 3 annular tears (Dallas Discogram Scale) were included in the study. Results Among 55 asymptomatic control group discs, 32 (58.2%) exhibited Grade 3 annular tear. All discs in the asymptomatic control group satisfied negative response criteria. Among 282 patient group discs, 199 (70.6%) exhibited Grade 3 annular tear. Of 199 discs with Grade 3 annular tears, 104 (52.3%) satisfied negative response criteria and were categorized as the Neg-D group. The other 95 discs were categorized as a Pos-D group. Patients showed significantly lower pain tolerance relative to control subjects (p Conclusions Pain tolerance was significantly lower in patients relative to asymptomatic subjects. Negative patient discs and asymptomatic subject discs showed similar characteristics. Pressure-controlled manometric discography using strict criteria may distinguish asymptomatic discs among morphologically abnormal discs with Grade 3 annular tears in patients with suspected chronic discogenic LBP.
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vibration pain provocation can improve the specificity of mri in the diagnosis of symptomatic lumbar disc rupture
The Clinical Journal of Pain, 1998Co-Authors: Heikki Vanharanta, Donna D Ohnmeiss, Charles AprillAbstract:Objective: The purpose of this study was to determine if vibration pain provocation could be combined with magnetic resonance imaging (MRI) to increase its specificity in identifying symptomatic disc disruption identified by discography. Design: Prospective single-blind study. Setting: Data were collected at a spine specialty clinic and at a diagnostic imaging center. Patients: A total of 206 discs in 78 patients (41 males, 37 females; average age, 39.7 years; range, 18-73 years) were evaluated by MRI, spinous process vibration, and discography. Interventions: A hand-held prototype vibrator was applied to the spinous process of each intervertebral disc level to be evaluated. The type of pain provoked with vibration as well as with discography was recorded as painless, dissimilar to clinical pain, or similar/exact reproduction of clinical pain. The discograms and MRI scans were scored on a 0-4 scale. A system was defined for combining the vibration results with MRI. Outcome Measures: The results of the vibration and MRI were compared with the results of computed tomography/discography to determine how well the results of the evaluations agreed. Results: Vibration pain provocation agreed with discographic pain provocation in 70.9% of the discs. The specificity of MRI compared with discographic findings was only 55.7%. However, this figure improved significantly to 81.3% when relying on the vibration pain provocation in discs with mild or moderate disruption. The sensitivity of the combined evaluation was 85.9% and the accuracy 83.0%. Conclusions: A small hand-held vibrator could produce pain provocation results similar to those obtained by discography. Results of this noninvasive pain provocation method can improve the specificity and accuracy of MRI in identifying symptomatic disc lesions.
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On the nature of neck pain, discography and cervical zygapophysial joint blocks
Pain, 1993Co-Authors: Nikolai Bogduk, Charles AprillAbstract:To determine the prevalence of disc pain and zygapophysial joint pain occurring simultaneously in the same segment of the neck, 56 patients with post-traumatic neck pain underwent both provocation discography and cervical zygapophysial joint blocks. Both a symptomatic disc and a symptomatic zygapophysial joint were identified in the same segment in 41% of the patients. Discs alone were symptomatic in only 20% of the sample. Zygapophysial joints were symptomatic but discs asymptomatic in 23%. Only 17% of the patients had neither a symptomatic disc nor a symptomatic zygapophysial joint at the segments studied. These observations indicate that the investigation of neck pain by discography alone or by zygapophysial blocks alone constitutes an inadequate approach to neck pain which fails to identify the majority of patients whose symptoms stem from multiple elements in the 3-joint complexes of the neck.
Sang Heon Lee - One of the best experts on this subject based on the ideXlab platform.
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Can magnetic resonance imaging accurately predict concordant pain provocation during provocative disc injection?
Skeletal Radiology, 2009Co-Authors: Chang Ho Kang, Richard Derby, Sang Heon Lee, Yun Hwan Kim, Jung Hyuk Kim, Kyoo Byung Chung, Deuk Jae SungAbstract:Objective To correlate magnetic resonance (MR) image findings with pain response by provocation discography in patients with discogenic low back pain, with an emphasis on the combination analysis of a high intensity zone (HIZ) and disc contour abnormalities. Materials and methods Sixty-two patients (aged 17–68 years) with axial low back pain that was likely to be disc related underwent lumbar discography (178 discs tested). The MR images were evaluated for disc degeneration, disc contour abnormalities, HIZ, and endplate abnormalities. Based on the combination of an HIZ and disc contour abnormalities, four classes were determined: (1) normal or bulging disc without HIZ; (2) normal or bulging disc with HIZ; (3) disc protrusion without HIZ; (4) disc protrusion with HIZ. These MR image findings and a new combined MR classification were analyzed in the base of concordant pain determined by discography. Results Disc protrusion with HIZ [sensitivity 45.5%; specificity 97.8%; positive predictive value (PPV), 87.0%] correlated significantly with concordant pain provocation ( P
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can magnetic resonance imaging accurately predict concordant pain provocation during provocative disc injection
Skeletal Radiology, 2009Co-Authors: Chang Ho Kang, Richard Derby, Sang Heon Lee, Yun Hwan Kim, Jung Hyuk Kim, Kyoo Byung Chung, Deuk Jae SungAbstract:To correlate magnetic resonance (MR) image findings with pain response by provocation discography in patients with discogenic low back pain, with an emphasis on the combination analysis of a high intensity zone (HIZ) and disc contour abnormalities. Sixty-two patients (aged 17–68 years) with axial low back pain that was likely to be disc related underwent lumbar discography (178 discs tested). The MR images were evaluated for disc degeneration, disc contour abnormalities, HIZ, and endplate abnormalities. Based on the combination of an HIZ and disc contour abnormalities, four classes were determined: (1) normal or bulging disc without HIZ; (2) normal or bulging disc with HIZ; (3) disc protrusion without HIZ; (4) disc protrusion with HIZ. These MR image findings and a new combined MR classification were analyzed in the base of concordant pain determined by discography. Disc protrusion with HIZ [sensitivity 45.5%; specificity 97.8%; positive predictive value (PPV), 87.0%] correlated significantly with concordant pain provocation (P < 0.01). A normal or bulging disc with HIZ was not associated with reproduction of pain. Disc degeneration (sensitivity 95.4%; specificity 38.8%; PPV 33.9%), disc protrusion (sensitivity 68.2%; specificity 80.6%; PPV 53.6%), and HIZ (sensitivity 56.8%; specificity 83.6%; PPV 53.2%) were not helpful in the identification of a disc with concordant pain. The proposed MR classification is useful to predict a disc with concordant pain. Disc protrusion with HIZ on MR imaging predicted positive discography in patients with discogenic low back pain.
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systematic review of lumbar provocation discography in asymptomatic subjects with a meta analysis of false positive rates
Pain Physician, 2008Co-Authors: Lee R. Wolfer, Richard Derby, Jeong-eun Lee, Sang Heon LeeAbstract:Background Lumbar provocation discography is a controversial diagnostic test. Currently, there is a concern that the test has an unacceptably high false-positive rate. Study design Systematic review and meta-analysis. Objective To perform a systematic review of lumbar discography studies in asymptomatic subjects and discs with a meta-analysis of the specificity and false-positive rate of lumbar discography. Methods A systematic review of the literature was conducted via a PUBMED search. Studies were included/excluded according to modern discography practices. Study quality was scored using the Agency for Healthcare Research and Quality (AHRQ) instrument for diagnostic accuracy. Specific data was extracted from studies and tabulated per published criteria and standards to determine the false-positive rates. A meta-analysis of specificity was performed. Strength of evidence was rated according to the AHRQ U.S. Preventive Services Task Force (USPSTF) criteria. Results Eleven studies were identified. Combining all extractable data, a false-positive rate of 9.3% per patient and 6.0% per disc is obtained. Data pooled from asymptomatic subjects without low back pain or confounding factors, shows a false-positive rate of 3.0% per patient and 2.1% per disc. In data pooled from chronic pain patients, asymptomatic of low back pain, the false-positive rate is 5.6% per patient and 3.85% per disc. Chronic pain does not appear to be a confounding factor in a chronic low back pain patient's ability to distinguish between positive (pathologic) and negative (non-pathologic) discs. Among additional asymptomatic patient subgroups analyzed, the false-positive rate per patient and per disc is as follows: iliac crest pain 12.5% and 7.1%; chronic neck pain 0%; somatization disorder 50% and 22.2%, and, post-discectomy 15% and 9.1%, respectively. In patients with chronic backache, no false-positive rate can be calculated. Low-pressure positive criteria ( Conclusions Strength of evidence is level II-2 based on the Agency for Healthcare Research Quality (USPSTF) for the diagnostic accuracy of discography. Contrary to recently published studies, discography has a low false-positive rate for the diagnosis of discogenic pain.
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The influence of psychologic factors on Diskography in patients with chronic axial low back pain.
Archives of physical medicine and rehabilitation, 2008Co-Authors: Richard Derby, Jeong-eun Lee, Sang Heon Lee, Yung Chen, Byung Jo Kim, Chang Hyung Lee, Young Ki Hong, Kwan Sik SeoAbstract:Abstract Derby R, Lee S-H, Chen Y, Kim B-J, Lee C-H, Hong Y-K, Lee J-E, Seo K-S. The influence of psychologic factors on Diskography in patients with chronic axial low back pain. Objective To determine whether a patient's presenting psychometric scores affect the findings of a pressure and injection speed–controlled manometric lumbar Diskography in patients with chronic low back pain (CLBP). Design A prospective, correlation-based, investigative study. Setting Free-standing ambulatory spine surgery center. Participants Two hundred sixty-three disks from 81 patients (54 men, 27 women). Intervention Diskography was performed using pressure and injection speed–controlled techniques. The patients were divided into psychometric subgroups (normal, at risk, abnormal) according to the Distress and Risk Assessment Method (DRAM). Main Outcome Measures The Diskography findings on each psychometric DRAM subgroup were evaluated. Results Across the individual psychometric categories, the positive rates of Diskography in the normal, at-risk, and abnormal subgroups were 75.0% (9/12), 59.5% (25/42), and 70.4% (19/27), respectively ( P >.05). The mean numeric rating scores of pain at 15 and 50psi above the opening pressure were similar in the 3 psychometric subgroups. There was no correlation between the Diskography results and the psychometric subgroupings. Conclusions In patients with CLBP, there is no correlation between the presenting psychometric DRAM score and the findings from pressure and injection speed–controlled manometric lumbar Diskography.
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The relation between annular disruption on computed tomography scan and pressure-controlled Diskography.
Archives of physical medicine and rehabilitation, 2005Co-Authors: Richard Derby, Yung Chen, Byung Jo Kim, Kwan Sik Seo, Sang Heon LeeAbstract:Abstract Derby R, Kim BJ, Chen Y, Seo KS, Lee SH. The relation between annular disruption on computed tomography scan and pressure-controlled Diskography. Objective To analyze the relation between annular disruption determined by computed tomography (CT) scan and diskographic findings using pressure-controlled manometric Diskography. Design Cross-sectional using prospectively gathered data. Setting Ambulatory spine intervention unit. Specimens Two hundred seventy-nine disks from 86 patients (55 men, 31 women) who were referred for Diskography of suspected chronic diskogenic low back pain. Interventions Not applicable. Main Outcome Measures The grade of annular disruption was rated using CT Diskography and fluoroscopic imaging as follows: 0 (no disruption); 1 (extension into the inner third of the annulus); 2 (extension into the middle third of the annulus); 3 (extension into the outer third of the annulus); 4 (circumferential extension with a >30° arc at the disk center); and 5 (contrast media leakage into the outer space). Diskography was performed via a pressure-controlled manometric technique using an injection rate of .05mL/s and a restricted total volume of 3.5mL. Pain was rated on a 0 to10 numeric rating scale (NRS). Criteria for symptomatic disks included provocation of patient concordant pain (NRS score, ≥6/10) at 50psi or less above opening pressure, with 3.5mL or less of total volume. Symptomatic disks were classified as "low pressure sensitive" or "high pressure sensitive" based on the pressure level that evoked pain. Disks classified as low pressure sensitive required an NRS score of 6 out of 10 or higher at 15psi or less above opening pressure. Disks classified as high pressure sensitive required an NRS score of 6 out of 10 or higher at pressures within a range of 15 to 50psi. Results The numbers of disks at each annular disruption grade were 19 (6.8%) at grade 0, 29 (10.4%) at grade 1, 35 (12.5%) at grade 2, 42 (15.1%) at grade 3, 69 (24.7%) at grade 4, and 85 (30.5%) at grade 5. A total of 93 disks met the criteria for a symptomatic disk. The extent of annular disruption and the rate of symptomatic disks correlated significantly ( P P Conclusions Annular disruption reaching the outer annulus fibrosus is a key factor in pain generation. Disk morphology, including annular disruptions extending beyond the outer annulus, may permit increased Diskography specificity.
Milan Stojanovic - One of the best experts on this subject based on the ideXlab platform.
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Does Needle Insertion Site Affect Diskography Results? A Retrospective Analysis
2015Co-Authors: Steven P. Cohen, Gregory V. Fant, Ronald Oberfoell, Thomas Larkin, Milan StojanovicAbstract:Study Design. A retrospective clinical data analysis was performed. Objectives. To determine the effect of needle insertion site on provocative Diskography results, and to ascertain whether performing Diskography ipsilaterally to a patient’s reported pain leads to a higher rate of false-positives. Summary of Background Data. In certain groups of patients, provocative Diskography is associated with a significant false-positive rate, which can lead to misdiag-nosis and inappropriate treatment. Although purported by some to be a cause of false-positive diskogram results, the effect of needle insertion site on Diskography results has yet to be determined. Methods. The charts of 127 patients who underwent Diskography were evaluated to determine the relationshi
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Does needle insertion site affect Diskography results? A retrospective analysis.
Spine, 2002Co-Authors: Steven P. Cohen, Thomas M. Larkin, Gregory V. Fant, Ronald Oberfoell, Milan StojanovicAbstract:Study Design. A retrospective clinical data analysis was performed. Objectives. To determine the effect of needle insertion site on provocative Diskography results, and to ascertain whether performing Diskography ipsilaterally to a patient’s reported pain leads to a higher rate of false-positives. Summary of Background Data. In certain groups of patients, provocative Diskography is associated with a significant false-positive rate, which can lead to misdiagnosis and inappropriate treatment. Although purported by some to be a cause of false-positive diskogram results, the effect of needle insertion site on Diskography results has yet to be determined. Methods. The charts of 127 patients who underwent Diskography were evaluated to determine the relationship between the location of pain, needle insertion site, and Diskography results. Results. Performing Diskography on the side ipsilateral to a patient’s pain did not result in a higher incidence of positive diskogram results. Conclusion. False-positive Diskography results are unlikely to result from performing the procedure on the same side as a patient’s reported pain.
Heikki Vanharanta - One of the best experts on this subject based on the ideXlab platform.
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Endplate degeneration observed on magnetic resonance imaging of the lumbar spine: correlation with pain provocation and disc changes observed on computed tomography Diskography.
Spine, 2002Co-Authors: Salla-maarit Kokkonen, Mauno Kurunlahti, Osmo Tervonen, Eero Ilkko, Heikki VanharantaAbstract:STUDY DESIGN One hundred and three lumbar intervertebral discs (L3/4-L5/S1) of 36 patients with low back pain were examined with computed tomography (CT) Diskography and magnetic resonance imaging (MRI). OBJECTIVES To determine whether lumbar endplate degeneration correlates with the degree of disc degeneration or disc rupture and to determine if there is an association between pain provocation during Diskography and lumbar endplate degeneration. SUMMARY OF BACKGROUND DATA There have been numerous attempts to explain the pathogenesis of pain provocation during Diskography, but the possibility of endplate degeneration as a source of pain has not been widely assessed. METHODS One hundred and three lumbar intervertebral discs (36 L3/4, 36 L4/5, and 31 L5/S1 intervertebral discs) of 36 patients were examined. On the basis of MRI, the intervertebral discs were divided into four categories based on the degree of endplate degeneration. Based on pain provocation on Diskography, the intervertebral discs were divided into three categories: no pain, indifferent/untypical pain, and familiar/typical pain. Based on disc degeneration and disc rupture, the intervertebral discs were divided into four categories in accordance with the Dallas Discogram Description: Grades 0-3 of both degeneration and rupture. RESULTS There was a positive correlation between endplate degeneration and disc degeneration and a positive correlation between disc rupture and pain provocation, but there was no association between endplate degeneration and disc rupture and no correlation between endplate degeneration and pain provocation on Diskography. CONCLUSIONS This study showed a stronger association between endplate degeneration and disc degeneration than between endplate degeneration and disc rupture. The results indicate that the contrast injection during Diskography reflects mainly pain of discogenic origin, whereas the possible pain associated with endplate damage cannot be depicted by CT Diskography.
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vibration pain provocation can improve the specificity of mri in the diagnosis of symptomatic lumbar disc rupture
The Clinical Journal of Pain, 1998Co-Authors: Heikki Vanharanta, Donna D Ohnmeiss, Charles AprillAbstract:Objective: The purpose of this study was to determine if vibration pain provocation could be combined with magnetic resonance imaging (MRI) to increase its specificity in identifying symptomatic disc disruption identified by discography. Design: Prospective single-blind study. Setting: Data were collected at a spine specialty clinic and at a diagnostic imaging center. Patients: A total of 206 discs in 78 patients (41 males, 37 females; average age, 39.7 years; range, 18-73 years) were evaluated by MRI, spinous process vibration, and discography. Interventions: A hand-held prototype vibrator was applied to the spinous process of each intervertebral disc level to be evaluated. The type of pain provoked with vibration as well as with discography was recorded as painless, dissimilar to clinical pain, or similar/exact reproduction of clinical pain. The discograms and MRI scans were scored on a 0-4 scale. A system was defined for combining the vibration results with MRI. Outcome Measures: The results of the vibration and MRI were compared with the results of computed tomography/discography to determine how well the results of the evaluations agreed. Results: Vibration pain provocation agreed with discographic pain provocation in 70.9% of the discs. The specificity of MRI compared with discographic findings was only 55.7%. However, this figure improved significantly to 81.3% when relying on the vibration pain provocation in discs with mild or moderate disruption. The sensitivity of the combined evaluation was 85.9% and the accuracy 83.0%. Conclusions: A small hand-held vibrator could produce pain provocation results similar to those obtained by discography. Results of this noninvasive pain provocation method can improve the specificity and accuracy of MRI in identifying symptomatic disc lesions.