engleski

Provocative discography screening improves surgical outcome

Object: The objective of this study was to compare the surgical outcomes of patients operated on without discography and patients that underwent discography prior to operation. Methods: The study was designed as a randomized controlled trial, using power analysis with McNemar’s Test on two correlated proportions. The study was comprised of 310 patients divided into trial (No=207) and control (No=103) groups. Inclusion criteria were low back pain resistant to nonsurgical treatment for more than 6 months and conventional radiological findings showing degenerative changes without a clear generator of pain. Exclusion criteria were red flags (tumor, trauma, infection). After standard radiological diagnostic imaging (x-ray, CT and MR) patients filled in Oswestry Disability Index (ODI), SF-36, Zung and MSPQ questionnaires. Depending on their radiological findings patients were included and randomly placed in the trial or control group. At the 1-year follow-up examination patients filled in ODI, SF-36, Likert scale questionnaires analyzing satisfaction with the procedure and to answer the question “Would he / she repeat discography if it would be necessary?”. Results: In the trial group 72 patients had degenerative disc disease (DDD) and 84 had degenerative changes on facet joints, stenosing canal, discopathy with sagital or coronal plane displacement but without sagital, coronal disbalance or another generator of pain. This group was classified as the subgroup with other indications. In the control group 57 patients had DDD and 46 patients had other indications. The difference between preoperative and postoperative ODI in the control group DDD subgroup was 22.07%. The difference between preoperative and postoperative ODI in the trial group DDD subgroup was 35.04%. Differences between preoperative and postoperative ODI in the control group other indications subgroup was 26.13%. Differences between preoperative and postoperative ODI in the trial group other indications subgroup was 28.42%. Conclusion: DDD treated surgically without discography did not reach the clinically significant improvement of 15 ODI points for the patients treated with fusion. Provocative discography screening with psychological testing in the trial group made improvement following fusion clinically significant. For other degenerative generators of pain, discography did not prove to be a useful diagnostic tool. As there were no post discography spondilodiscitis and patients were willing to repeat the procedure, our results suggest discography use in preoperative workup in patients with DDD.

Provocative discography; MR; DDD

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