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Possible predictive markers to make a decision for surgical intervention in discography

Year 2019, Volume: 10 Issue: 2, 197 - 208, 12.06.2019
https://doi.org/10.18663/tjcl.459085

Abstract

Aim:
In this retrospective study, the diagnostic and therapeutic events of
discography and disc-blockage (discoblock) were investigated in patients whose
clinical symptoms could not be explained by CT and/or MR images.

Material
and Methods:
The study included patients applied
with discography between August 2014 and October 2016.  Patient data were recorded, consisting of age,
gender, pre-procedure Visual Analogue Scale (VAS) score (PRE-VAS),
post-procedure VAS score (POST-VAS), and pre-procedure “Japanese Orthopedic Association” (JOA) score (PRE-JOA),
post-procedure JOA score (POST-JOA), long-term follow-up VAS score (FOLLOW-VAS)
and JOA score (FOLLOW-JOA), level of herniated disc in the spinal column (L1-2,
L2-3, L3-4, L4-5, L5-S1), size of herniated disc ("bulging",
"protrusion", "extrusion") and localization of the herniated
disc in the spinal canal (median or foraminal).

Results:
Evaluation was made of a total of 22 patients (11 females, 11 males) aged 32 - 60
years. Discectomy after discography and/or discoblock was applied to 12 patients.
The PRE-VAS scores of patients who underwent discectomy were higher than those
of patients who did not undergo surgery, and the scores were lower in the
postoperative period than those of the unoperated group. The long term (6
months) follow-up results indicated that patients with discectomy and those
without surgery had similar levels of pain. The JOA scores of patients with
discectomy were higher than those of patients without surgery.







Conclusion:
At
the end of this study, it was thought that discography and discoblock procedure
could be an adjunctive test for decision-making in respect of surgery for
patients who were not diagnosed using radiological views and clinical symptoms.
Furthermore, it was considered that the VAS score applied before and after
discography may identify the patients who will be applied with discectomy.

References

  • 1. Frymoyer JW. Back pain and sciatica. N Engl J Med 1988; 318: 291-300.
  • 2. Smith BM, Hurwitz EL, Solsberg D, Rubinstein D, Corenman DS, Dwyer AP, Kleiner J. Interobserver reliability of detecting lumbar intervertebral disc high-intensity zone on magnetic resonance imaging and association of high-intensity zone with pain and anular disruption. Spine (Phila Pa 1976) 1998; 23: 2074-80.
  • 3. Jarvik JG, Deyo RA. Imaging of lumbar intervertebral disk degeneration and aging, excluding disk herniations. Radiol Clin North Am 2000; 38: 1255-66
  • 4. Carragee EJ, Chen Y, Tanner CM, Truong T, Lau E, Brito JL. Provocative discography in patients after limited lumbar discectomy: A controlled, randomized study of pain response in symptomatic and asymptomatic subjects. Spine (Phila Pa 1976) 2000; 25: 306530-71.
  • 5. Carragee EJ, Paragioudakis SJ, Khurana S. 2000 Volvo Award winner in clinical studies: Lumbar high-intensity zone and discography in subjects without low back problems. Spine (Phila Pa 1976) 2000; 25: 2987-92.
  • 6. Jinkins JR, Rauch RA, Gee GT, Bazan C 3rd, Xiong L, Kashanian FK, Hanna EP. Lumbosacral spine: early and delayed MR imaging after administration of an expanded dose of gadopentetate dimeglumine in healthy, asymptomatic subjects. Radiology 1995; 197: 247-51.
  • 7. Ohtori S, Kinoshita T, Yamashita M et al. Results of surgery for discogenic low back pain: a randomized study using discography versus discoblock for diagnosis. Spine (Phila Pa 1976) 2009; 34: 1345-48.
  • 8. Kambin P, Savitz MH. Arthroscopic microdiscectomy: an alternative to open disc surgery. Mt Sinai J Med 2000; 67: 283-87.
  • 9. Kambin P. Arthroscopic microdiscectomy. Arthroscopy 1992; 8: 287-95.
  • 10. Boonstra AM, Schiphorst Preuper HR, Reneman MF, Posthumus JB, Stewart RE. Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain. Int J Rehabil Res 2008; 31: 165-69.
  • 11. Vitzthum HE, Dalitz K. Analysis of five specific scores for cervical spondylogenic myelopathy. Eur Spine J 2007; 16: 2096-103
  • 12. Tehranzadeh J. Discography 2000. Radiol Clin North Am 1998; 36: 463-95.
  • 13. Cohen SP, Larkin TM, Barna SA, Palmer WE, Hecht AC, Stojanovic MP. Lumbar discography: a comprehensive review of outcome studies, diagnostic accuracy, and principles. Reg Anesth Pain Med 2005; 30: 163-83.
  • 14. Schliessbach J, Siegenthaler A, Heini P, Bogduk N, Curatolo M. Blockade of the sinuvertebral nerve for the diagnosis of lumbar diskogenic pain: an exploratory study. Anesth Analg 2010; 111: 204-206.
  • 15. Peng B, Fu X, Pang X, Li D, Liu W, Gao C, Yang H. Prospective clinical study on natural history of discogenic low back pain at 4 years of follow-up. Pain Physician 2012; 15: 525-32.
  • 16. Aprill C, Bogduk N. High-intensity zone: a diagnostic sign of painful lumbar disc on magnetic resonance imaging. Br J Radiol 1992; 65: 361-69.
  • 17. Fukui S, Nitta K, Iwashita N, Tomie H, Nosaka S, Rohof O. Intradiscal pulsed radiofrequency for chronic lumbar discogenic low back pain: a one year prospective outcome study using discoblock for diagnosis. Pain Physician 2013; 16: 435-42.
  • 18. Weishaupt D, Zanetti M, Hodler J, Boos N. MR imaging of the lumbar spine: prevalence of intervertebral disk extrusion and sequestration, nerve root compression, end plate abnormalities, and osteoarthritis of the facet joints in asymptomatic volunteers. Radiology 1998; 209: 661-66.
  • 19. Tonosu J, Inanami H, Oka H et al. Diagnosing Discogenic Low Back Pain Associated with Degenerative Disc Disease Using a Medical Interview. PLoS One 2016; 11: 0166031.
  • 20. Alamin TF, Kim MJ, Agarwal V. Provocative lumbar discography versus functional anesthetic discography: a comparison of the results of two different diagnostic techniques in 52 patients with chronic low back pain. Spine J 2011; 11: 756-65.
  • 21. Carragee EJ, Alamin TF, Miller JL, Carragee JM. Discographic, MRI and psychosocial determinants of low back pain disability and remission: a prospective study in subjects with benign persistent back pain. Spine J 2005; 5: 24-35.
  • 22. Carragee EJ, Chen Y, Tanner CM, Hayward C, Rossi M, Hagle C. Can discography cause long-term back symptoms in previously asymptomatic subjects? Spine (Phila Pa 1976) 2000; 25: 1803-08.
  • 23. Putzier M, Streitparth F, Hartwig T, Perka CF, Hoff EK, Strube P. Can discoblock replace discography for identifying painful degenerated discs? Eur J Radiol 2013; 82: 1463-70.

Radyolojik görüntülerle klinik semptomları uyumlu olmayan lomber disk hernisi hastalarında diskografi uygulaması

Year 2019, Volume: 10 Issue: 2, 197 - 208, 12.06.2019
https://doi.org/10.18663/tjcl.459085

Abstract

Amaç:
Halen bazı mekanik veya intervertebral disk kökenli bel ağrılarında radyolojik
tanı yöntemleri her zaman yeterli olamayabilmektedir. Bu klinik çalışmada
mevcut klinik semptomları uygulanan BT ve/veya MR tetkiki görüntüleri ile
açıklanamayan hastalarda diskografi ve disk blokajı uygulamasının hastaların
tanı ve tedavisine fayda sağlayıp sağlamadığı araştırıldı.

Gereç
ve Yöntemler:
Çalışmaya Ağustos 2014 ile Ekim 2016
tarihleri arasında diskografi uygulanan hastalar dahil edildi. Bu hastalara
ameliyat öncesi ve sonrası Görsel analog
skala (VAS)
Japanese Orthopedic
Association
(JOA) ölçeği
uygulandı. Disk blokajı sonrası ağrı
şikayeti azalmayan hastalar takibe alındı ve ağrı şikayeti azalan hastalara
standart mikrodiskektomi girişimi uygulandı. Hastalar altı ay süre ile
takip edildi ve bu süre sonunda bu hastalara tekrar başta uygulanan ölçekler
uygulandı.

Bulgular:Diskografi
yapılıp ameliyat edilmeyen hastalarda diskografi işlemi öncesi VAS puanının
fazla olmasının işlem sonrası VAS puanını arttırdığı gözlendi. Diskografi
öncesi JOA puanları düştükçe diskografi öncesi ve sonrası VAS puanlarının
yükseldiği gözlendi. Yine diskografi öncesi VAS puanının yüksek olduğu koşulda
diskografi sonrası VAS puanının da yüksek olacağı görüldü. Bu bulgularla
diskografinin ağrı üzerine etkisinin olmadığı düşünüldü. Oysa diskektomi
yapılan grupta ameliyat öncesi VAS ve JOA puanı düşük olduğu koşulda ameliyat
sonrası JOA puanının arttığı ve erkek hastalarda uzun dönem takipte VAS
puanlarının daha düşük bulunduğu saptandı. Ayrıca diskektomi yapıldığı koşulda
ameliyat sonrası JOA puanlarının artarken VAS puanlarının azaldığı düşünüldü.
Bu bulgularla diskektominin hem ağrıyı azalttığı ve hem de JOA puanını
arttırdığı düşünüldü. 







            Sonuç: Bu çalışmanın sonunda radyolojik
görüntüleri ile klinik semptomları birbiri ile uyuşmayan hastalarda ameliyatla
tedavi kararını verebilmek için diskografinin ve diskoblok işleminin yardımcı
bir test olabileceği düşünüldü.

References

  • 1. Frymoyer JW. Back pain and sciatica. N Engl J Med 1988; 318: 291-300.
  • 2. Smith BM, Hurwitz EL, Solsberg D, Rubinstein D, Corenman DS, Dwyer AP, Kleiner J. Interobserver reliability of detecting lumbar intervertebral disc high-intensity zone on magnetic resonance imaging and association of high-intensity zone with pain and anular disruption. Spine (Phila Pa 1976) 1998; 23: 2074-80.
  • 3. Jarvik JG, Deyo RA. Imaging of lumbar intervertebral disk degeneration and aging, excluding disk herniations. Radiol Clin North Am 2000; 38: 1255-66
  • 4. Carragee EJ, Chen Y, Tanner CM, Truong T, Lau E, Brito JL. Provocative discography in patients after limited lumbar discectomy: A controlled, randomized study of pain response in symptomatic and asymptomatic subjects. Spine (Phila Pa 1976) 2000; 25: 306530-71.
  • 5. Carragee EJ, Paragioudakis SJ, Khurana S. 2000 Volvo Award winner in clinical studies: Lumbar high-intensity zone and discography in subjects without low back problems. Spine (Phila Pa 1976) 2000; 25: 2987-92.
  • 6. Jinkins JR, Rauch RA, Gee GT, Bazan C 3rd, Xiong L, Kashanian FK, Hanna EP. Lumbosacral spine: early and delayed MR imaging after administration of an expanded dose of gadopentetate dimeglumine in healthy, asymptomatic subjects. Radiology 1995; 197: 247-51.
  • 7. Ohtori S, Kinoshita T, Yamashita M et al. Results of surgery for discogenic low back pain: a randomized study using discography versus discoblock for diagnosis. Spine (Phila Pa 1976) 2009; 34: 1345-48.
  • 8. Kambin P, Savitz MH. Arthroscopic microdiscectomy: an alternative to open disc surgery. Mt Sinai J Med 2000; 67: 283-87.
  • 9. Kambin P. Arthroscopic microdiscectomy. Arthroscopy 1992; 8: 287-95.
  • 10. Boonstra AM, Schiphorst Preuper HR, Reneman MF, Posthumus JB, Stewart RE. Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain. Int J Rehabil Res 2008; 31: 165-69.
  • 11. Vitzthum HE, Dalitz K. Analysis of five specific scores for cervical spondylogenic myelopathy. Eur Spine J 2007; 16: 2096-103
  • 12. Tehranzadeh J. Discography 2000. Radiol Clin North Am 1998; 36: 463-95.
  • 13. Cohen SP, Larkin TM, Barna SA, Palmer WE, Hecht AC, Stojanovic MP. Lumbar discography: a comprehensive review of outcome studies, diagnostic accuracy, and principles. Reg Anesth Pain Med 2005; 30: 163-83.
  • 14. Schliessbach J, Siegenthaler A, Heini P, Bogduk N, Curatolo M. Blockade of the sinuvertebral nerve for the diagnosis of lumbar diskogenic pain: an exploratory study. Anesth Analg 2010; 111: 204-206.
  • 15. Peng B, Fu X, Pang X, Li D, Liu W, Gao C, Yang H. Prospective clinical study on natural history of discogenic low back pain at 4 years of follow-up. Pain Physician 2012; 15: 525-32.
  • 16. Aprill C, Bogduk N. High-intensity zone: a diagnostic sign of painful lumbar disc on magnetic resonance imaging. Br J Radiol 1992; 65: 361-69.
  • 17. Fukui S, Nitta K, Iwashita N, Tomie H, Nosaka S, Rohof O. Intradiscal pulsed radiofrequency for chronic lumbar discogenic low back pain: a one year prospective outcome study using discoblock for diagnosis. Pain Physician 2013; 16: 435-42.
  • 18. Weishaupt D, Zanetti M, Hodler J, Boos N. MR imaging of the lumbar spine: prevalence of intervertebral disk extrusion and sequestration, nerve root compression, end plate abnormalities, and osteoarthritis of the facet joints in asymptomatic volunteers. Radiology 1998; 209: 661-66.
  • 19. Tonosu J, Inanami H, Oka H et al. Diagnosing Discogenic Low Back Pain Associated with Degenerative Disc Disease Using a Medical Interview. PLoS One 2016; 11: 0166031.
  • 20. Alamin TF, Kim MJ, Agarwal V. Provocative lumbar discography versus functional anesthetic discography: a comparison of the results of two different diagnostic techniques in 52 patients with chronic low back pain. Spine J 2011; 11: 756-65.
  • 21. Carragee EJ, Alamin TF, Miller JL, Carragee JM. Discographic, MRI and psychosocial determinants of low back pain disability and remission: a prospective study in subjects with benign persistent back pain. Spine J 2005; 5: 24-35.
  • 22. Carragee EJ, Chen Y, Tanner CM, Hayward C, Rossi M, Hagle C. Can discography cause long-term back symptoms in previously asymptomatic subjects? Spine (Phila Pa 1976) 2000; 25: 1803-08.
  • 23. Putzier M, Streitparth F, Hartwig T, Perka CF, Hoff EK, Strube P. Can discoblock replace discography for identifying painful degenerated discs? Eur J Radiol 2013; 82: 1463-70.
There are 23 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Orıgınal Artıcle
Authors

Mustafa Ogden 0000-0002-7129-0936

Ulaş Yüksel This is me

Süleyman Akkaya

İbrahim Umut Bulut This is me

Bülent Bakar

Mehmet Faik Özveren

Publication Date June 12, 2019
Published in Issue Year 2019 Volume: 10 Issue: 2

Cite

APA Ogden, M., Yüksel, U., Akkaya, S., Bulut, İ. U., et al. (2019). Possible predictive markers to make a decision for surgical intervention in discography. Turkish Journal of Clinics and Laboratory, 10(2), 197-208. https://doi.org/10.18663/tjcl.459085
AMA Ogden M, Yüksel U, Akkaya S, Bulut İU, Bakar B, Özveren MF. Possible predictive markers to make a decision for surgical intervention in discography. TJCL. June 2019;10(2):197-208. doi:10.18663/tjcl.459085
Chicago Ogden, Mustafa, Ulaş Yüksel, Süleyman Akkaya, İbrahim Umut Bulut, Bülent Bakar, and Mehmet Faik Özveren. “Possible Predictive Markers to Make a Decision for Surgical Intervention in Discography”. Turkish Journal of Clinics and Laboratory 10, no. 2 (June 2019): 197-208. https://doi.org/10.18663/tjcl.459085.
EndNote Ogden M, Yüksel U, Akkaya S, Bulut İU, Bakar B, Özveren MF (June 1, 2019) Possible predictive markers to make a decision for surgical intervention in discography. Turkish Journal of Clinics and Laboratory 10 2 197–208.
IEEE M. Ogden, U. Yüksel, S. Akkaya, İ. U. Bulut, B. Bakar, and M. F. Özveren, “Possible predictive markers to make a decision for surgical intervention in discography”, TJCL, vol. 10, no. 2, pp. 197–208, 2019, doi: 10.18663/tjcl.459085.
ISNAD Ogden, Mustafa et al. “Possible Predictive Markers to Make a Decision for Surgical Intervention in Discography”. Turkish Journal of Clinics and Laboratory 10/2 (June 2019), 197-208. https://doi.org/10.18663/tjcl.459085.
JAMA Ogden M, Yüksel U, Akkaya S, Bulut İU, Bakar B, Özveren MF. Possible predictive markers to make a decision for surgical intervention in discography. TJCL. 2019;10:197–208.
MLA Ogden, Mustafa et al. “Possible Predictive Markers to Make a Decision for Surgical Intervention in Discography”. Turkish Journal of Clinics and Laboratory, vol. 10, no. 2, 2019, pp. 197-08, doi:10.18663/tjcl.459085.
Vancouver Ogden M, Yüksel U, Akkaya S, Bulut İU, Bakar B, Özveren MF. Possible predictive markers to make a decision for surgical intervention in discography. TJCL. 2019;10(2):197-208.


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