Document Detail

The transfer of disc pressure to adjacent discs in discography: a specificity problem?
MedLine Citation:
PMID:  20802394     Owner:  NLM     Status:  MEDLINE    
STUDY DESIGN: In vivo experimental study.
OBJECTIVE: The primary objective of the study was to investigate pressure transmission to adjacent discs during discography. A secondary objective was to quantify the transmitted pressure, both in contrast injected and noninjected porcine intervertebral discs.
SUMMARY OF BACKGROUND DATA: Discography is used to before surgery identify painful discs. A pain response during discography that is concordant with the patient's experienced back pain is regarded as an indication that the injected disc is the source of pain. However, the sensitivity and specificity of discography are matters of debate. Pressure-controlled discographies have been reported to reduce the number of false-positive discs using low pressure criteria. Preliminary data indicated a transfer of pressure from an injected to an adjacent disc during discography. Pressure transmission in vivo during lumbar discography, not reported before might, if clinically present, contribute to a false-positive diagnosis.
METHODS: Thirty-six lumbar discs in 9 adolescent pigs were investigated. Intradiscal pressure was recorded during contrast injection, using a 0.36/0.25 mm fiber-optic pressure transducer inserted into the nucleus pulposus via a 22 G needle. The pressure was measured simultaneously in 2 adjacent discs during contrast injection into 1 of the discs at pressures up to 8 bar. Transmitted pressure was recorded both in noninjected discs and in discs that were prefilled with contrast.
RESULTS: Thirty-three discs were successfully examined. During contrast injection, there was an intradiscal pressure rise in the adjacent disc with a median value of 16.0% (range, 3.2-37.0) over baseline pressure. There was no significant difference in pressure increase between the noninjected and prefilled discs (P < 0.68).
CONCLUSION: Discography of porcine discs induces a pressure increase in adjacent discs. A similar pressure transfer during human clinical discography might elicit false-positive pain reactions.
Hanna Hebelka; Arne Gaulitz; Andreas Nilsson; Sten Holm; Tommy Hansson
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Spine     Volume:  35     ISSN:  1528-1159     ISO Abbreviation:  Spine     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-17     Completed Date:  2011-01-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  E1025-9     Citation Subset:  IM    
Departments of Radiology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
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MeSH Terms
Back Pain / etiology*
False Positive Reactions
Intervertebral Disk / physiopathology,  radiography*
Lumbar Vertebrae / physiopathology,  radiography*
Models, Animal
Myelography / adverse effects*
Reproducibility of Results
Sensitivity and Specificity

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