Abstracts Posters SICOT-SOF meeting Gothenburg 2010 _2_

Poster
Topic: Spine
Abstract number: 25637
THE POSITIVE PREDICTIVE VALUE OF PROVOCATIVE DISCOGRAPHY IN
ARTIFICIAL DISC REPLACEMENT
Evalina BURGER 1 , Emily LINDLEY 1 , Blake SHERMAN 1 , Donna OHNMEISS 2 , Jack
ZIGLER 2 , Douglas KASOW 3 , Michael JANSSEN 4 , Vikas PATEL 1
1 University of Colorado Denver, Aurora (UNITED STATES), 2 Texas Back Institute,
Plano (UNITED STATES), 3 Providence Orthopaedic & Sports Medicine, Monroe
(UNITED STATES), 4 The Center for Spinal Disorders, Thornton (UNITED STATES)
Introduction: Identifying the source of low back pain is challenging in many patients,
despite advanced imaging techniques. Often, multiple levels will show some degree
of degenerative disc disease on imaging, and determining which level(s) should be
treated is difficult. In these patients with questionable pathology, provocative
discography is often performed. However, the use of discography remains highly
controversial. Methods: We retrospectively reviewed data from patients enrolled in
an FDA IDE study that were randomized to the artificial disc replacement (ADR) arm
and underwent positive low pressure provocative discography. ADR was performed
at L3-L4, L4-L5, or L5-S1. Clinical outcomes (Visual Analogue Scale, VAS; Oswestry
Disability Index, ODI) were assessed at 6 weeks and 3, 6, 12, and 24 months.
Results: Thirty-three patients had single-level positive low pressure discograms
during their diagnostic workup. At 12 months postoperative, 23 patients (74%) met
the high clinical success and the minimal acceptable change criteria. At 24 months,
24 patients (73%) met the high clinical success criteria and 28 patients (85%) met the
minimal acceptable change criteria. Conclusions: The positive predictive value of
discography was high when using outcomes after ADR to assess the diagnosis of
discogenic pain. Discography was generally reserved for patients with unclear
pathology or symptomology in this study. However, even in these difficult to diagnose
patients, the predictive value of positive discography was 73-85%. These results
suggest that future prospective studies may benefit from using outcomes after ADR
when investigating the predictive value of discography.
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