A group of researchers examined a discogram's impact on adjacent levels for back pain patients and published their results in Spine.
The researchers performed 25 discograms on nine consecutive patients. They measured intradiscal pressure in 22 adjacent discs and found seven were not filled with contrast and 15 were prefilled from the previous discogram. Here are five things to know about the study and discograms in the future:
1. There was an average pressure increase of 13 psi on 55 percent of the adjacent discs. This corresponded with a 62 percent increase above baseline. This is a Level 1, observational in vivo clinical study.
2. Of the discograms including pressure transmission, all had Pfirrmann degeneration grade of three or more. Around 75 percent of the adjacent discs with increased pressure had degeneration of three or more. The study authors concluded that pressure transmission during discography constituted a potentially major source of false-positive responses, questioning whether discography can provoke pain at just the single disc level.
3. The maximum pressure in injected discs averaged 35 psi above opening pressure range. "Clinical discography induces pressure increase in adjacent discs," the study authors concluded. "The induced pressure increase was of a clinically relevant magnitude and was evident despite low absolute pressure in the injected disc."
4. A 2013 article updated the systematic review and accuracy of lumbar discography in chronic low back pain found lumbar provocation discography performed according to International Association for the Study of Pain criteria could be a useful tool for evaluating chronic lumbar discogenic pain. The prevalence of internal disc disruption was estimated at 39 percent to 42 percent, compared with the prevalence of discogenic pain without assessing internal disc disruption, which is 26 percent.
5. The Millennium Research Group reported in their "US Markets for Minimally Invasive Spine Technology" that both intradiscal therapy and discography segments will undergo minimal growth "due to issues surrounding reimbursement and decelerated growth of the spine market."
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