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Comparison of pressure-controlled provocation discography using automated versus manual syringe pump manometry in patients with chronic low back pain.
MedLine Citation:
PMID:  21040439     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
PURPOSE: The study compares the rate of positive discograms using an automated versus a manual pressure-controlled injection devise and compares the pressure and volume values at various pressures and initial evoked pain and 6/10 or greater evoked pain.
STUDY DESIGN: A retrospective study prospectively collected patient study data used in a prior prospective study and with prospectively collected data which is routinely collected per our institutional standardized audit protocol. Two custom-built disc manometers (automated injection speed control; manual injection speed control) were sequentially employed during provocation discography in 510 discs of 151 consecutive patients. Two hundred thirty-seven discs of 67 patients with chronic low back pain were evaluated using the automated manometer (automated group) and 273 discs of 84 patients were evaluated with a manual manometer (manual group).
RESULT: No significant differences in positive discogram rates were found between the automated and manual groups (32.1% vs 32.6% per disc, respectively, P>0.05). No significant differences in low-pressure positive discogram rates were found (16.0% vs 15.0% per disc, automated group versus manual group, respectively, P>0.05). However, there were significantly increased volumes and lower pressures at initial and "bad" pain provocation.
CONCLUSION: The study results found equivalent positive discogram rates following a series of pressure-controlled discography using either an automated or manual pressure devise. There were, however significant increases in volume at both initial onset of evoked pain and at 6/10 pain when using the automated injection devise that may have caused the observed lower opening pressure and lower pressure values at initial evoked pain. Assuming increased volumes are innocuous, automated injection is inherently more controlled and may better reduce unintended and often unrecorded spurious high dynamic pressure peaks thereby reducing conscious and unconscious operator bias.
Authors:
Richard Derby; Sang Hoon Lee; Jeong-Eun Lee; Sang-Heon Lee
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Publication Detail:
Type:  Journal Article     Date:  2010-10-28
Journal Detail:
Title:  Pain medicine (Malden, Mass.)     Volume:  12     ISSN:  1526-4637     ISO Abbreviation:  Pain Med     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-01-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100894201     Medline TA:  Pain Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  18-26     Citation Subset:  IM    
Copyright Information:
Wiley Periodicals, Inc.
Affiliation:
Spinal Diagnostics and Treatment Center, 901 Campus Drive, Daly City, CA 94015, USA.
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