Provocative Discography: Section 4

The primary indication for provocative discography is to determine whether a patient with chronic spinal pain, who has failed aggressive efforts at conservative care, can be helped with spinal fusion.

In contrast to the surgical treatment of radiculopathy, the surgical treatment of axial pain is controversial, as studies have demonstrated a wide disparity in outcomes. This disparity has been attributed to a number of factors, including type of fusion (interbody vs intertransverse, instrumented vs non-instrumented), approach (anterior vs posterior vs 360 degree), surgeon variability, and methodological differences (outcome measure, interval to follow-up, etc.).

Colhoun, et al. Provocation Discography as a Guide to Planning Operations on the Spine. 1988 JBJS(Br) 70B:267-71.

Wetzel, et al. The Treatment of Lumbar Spinal Pain Syndromes Diagnosed by Discography. Spine 1994 19:7;792-800.

Fluke. Letter to the editor. Spine 1995 20:4;501-4.

Gill, et al. Functional Results After Anterior Lumbar Fusion at L5-S1 in Patients with Normal and Abnormal MRI Scans. Spine 1992 17:8;940-2.

Newman et al. Anterior Lumbar Interbody Fusion for Internal Disc Disruption. Spine 1992 17:7; 831-33.

Simmons, et al. An Evaluation of Discography in the Localization of Symptomatic Levels in Discogenic Disease of the Spine. Clinical Orthopedics and related Research. May, 1975. 108:57-69.

Parker, et al. The outcome of posterolateral fusion in highly selected patients with discogenic low back pain. Spine 1996 21:15:1835-8.

Greenough, CG, et al. Lumbar spinal fusion: a comparison of anterior and instrumented posterolateral technique. ISSLS abstracts, Vermont, June 1996.

Knox, BD, et al. Anterior lumbar interbody fusion for discogram concordant pain. Journal of Spinal Disorders 1993;6(3):242-4.

Lee CK, et al. Chronic disabling low back pain syndrome caused by internal disc derangements: the results of disc excision and posterior lumbar interbody fusion. Spine 1995 20(3):356-61.

Kuslitch BAK study.

Vamvanji, V, et al. Outcome and intertransverse fusion in internal disc disruption. ISSLS abstracts June 1996.

While the results from discography have been an important part of the preoperative evaluation in most of these studies, typically the criteria for a positive test have not been strictly defined.