Low-Pressure Lumbar Provocation Discography According to Spine Intervention Society/International Association for the Study of Pain Standards Does Not Cause Acceleration of Disc Degeneration in Patients with Symptomatic Low Back Pain: A 7-Year Matched Cohort Study

Zachary L. McCormick, Vance T Lehman, Christopher T. Plastaras, David R. Walega, Paul Huddleston, Charbel Moussallem, Jennifer R. Geske, Jared T. Verdoorn, David J. Kennedy, Timothy Maus, Carrie Carr

Research output: Contribution to journalArticle

Abstract

Study Design. Retrospective matched cohort study. Objective. To determine if low-pressure lumbar provocation discography (PD) results in long-term accelerated disc degeneration, internal disc disruption, or disc herniation in patients with symptomatic low back pain (LBP).Summary of Background Data. Study of subjects without clinically-significant LBP suggests that high-pressure PD may accelerate disc degeneration. Methods. Consecutive patients with symptomatic LBP who underwent magnetic resonance imaging (MRI), PD, and repeat MRI more than 7 years later, but did not undergo subsequent spinal fusion surgery, were included. Punctured discs were matched (1:2 to 1:4) to corresponding discs in a control cohort by age, BMI, Pfirrmann score (±2), and presence of disc herniation; control cohort inclusion required MRIs for symptomatic LBP, separated by more than 7 years. The primary outcome of the study was a progression in Pfirrmann score category (I-II, III-IV, V). MRI disc-to-CSF T2 signal-intensity ratio, disc height, disc herniations, high intensity zones (HIZs), and Modic changes were assessed. Results. Baseline and follow-up MRIs were available for 77 discs exposed to PD, and for 260 discs in the matched control cohort. There was no difference in the proportion of punctured discs that advanced in Pfirrmann score category in the PD group (17%, 95% CI 9-27%) compared with corresponding discs in the Control group (21%, 95% CI 17-27%), P = 0.3578, or in non-punctured discs in the PD group (35%, 95% CI 21-51%) compared with corresponding discs in the Control group (34%, 95% CI 27-42%), P = 0.1169. There were no differences in disc-to-CSF T2 signal-intensity ratio, presence of disc herniations, HIZs, or Modic changes following puncture in the PD versus matched cohort discs or in the non-punctured PD cohort discs versus corresponding control cohort discs (P > 0.05).Conclusion. Patients with symptomatic LBP who underwent low-pressure PD, but who did not undergo a subsequent spinal fusion surgery, developed disc degeneration and new disc herniations at a similar rate to corresponding discs in matched control patients.

Original languageEnglish (US)
Pages (from-to)E1161-E1168
JournalSpine
Volume44
Issue number19
DOIs
StatePublished - Oct 1 2019

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Intervertebral Disc Degeneration
Low Back Pain
Spine
Cohort Studies
Pressure
Spinal Fusion
Magnetic Resonance Imaging
Control Groups
Punctures
Outcome Assessment (Health Care)

Keywords

  • accelerated disc degeneration
  • chronic low back pain
  • disc abnormalities
  • disc herniation
  • disc stimulation
  • discogenic pain
  • fluoroscopic guidance
  • magnetic resonance imaging
  • Pfirrmann score
  • provocation discography
  • symptomatic low back pain

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Low-Pressure Lumbar Provocation Discography According to Spine Intervention Society/International Association for the Study of Pain Standards Does Not Cause Acceleration of Disc Degeneration in Patients with Symptomatic Low Back Pain : A 7-Year Matched Cohort Study. / McCormick, Zachary L.; Lehman, Vance T; Plastaras, Christopher T.; Walega, David R.; Huddleston, Paul; Moussallem, Charbel; Geske, Jennifer R.; Verdoorn, Jared T.; Kennedy, David J.; Maus, Timothy; Carr, Carrie.

In: Spine, Vol. 44, No. 19, 01.10.2019, p. E1161-E1168.

Research output: Contribution to journalArticle

McCormick, Zachary L. ; Lehman, Vance T ; Plastaras, Christopher T. ; Walega, David R. ; Huddleston, Paul ; Moussallem, Charbel ; Geske, Jennifer R. ; Verdoorn, Jared T. ; Kennedy, David J. ; Maus, Timothy ; Carr, Carrie. / Low-Pressure Lumbar Provocation Discography According to Spine Intervention Society/International Association for the Study of Pain Standards Does Not Cause Acceleration of Disc Degeneration in Patients with Symptomatic Low Back Pain : A 7-Year Matched Cohort Study. In: Spine. 2019 ; Vol. 44, No. 19. pp. E1161-E1168.
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title = "Low-Pressure Lumbar Provocation Discography According to Spine Intervention Society/International Association for the Study of Pain Standards Does Not Cause Acceleration of Disc Degeneration in Patients with Symptomatic Low Back Pain: A 7-Year Matched Cohort Study",
abstract = "Study Design. Retrospective matched cohort study. Objective. To determine if low-pressure lumbar provocation discography (PD) results in long-term accelerated disc degeneration, internal disc disruption, or disc herniation in patients with symptomatic low back pain (LBP).Summary of Background Data. Study of subjects without clinically-significant LBP suggests that high-pressure PD may accelerate disc degeneration. Methods. Consecutive patients with symptomatic LBP who underwent magnetic resonance imaging (MRI), PD, and repeat MRI more than 7 years later, but did not undergo subsequent spinal fusion surgery, were included. Punctured discs were matched (1:2 to 1:4) to corresponding discs in a control cohort by age, BMI, Pfirrmann score (±2), and presence of disc herniation; control cohort inclusion required MRIs for symptomatic LBP, separated by more than 7 years. The primary outcome of the study was a progression in Pfirrmann score category (I-II, III-IV, V). MRI disc-to-CSF T2 signal-intensity ratio, disc height, disc herniations, high intensity zones (HIZs), and Modic changes were assessed. Results. Baseline and follow-up MRIs were available for 77 discs exposed to PD, and for 260 discs in the matched control cohort. There was no difference in the proportion of punctured discs that advanced in Pfirrmann score category in the PD group (17{\%}, 95{\%} CI 9-27{\%}) compared with corresponding discs in the Control group (21{\%}, 95{\%} CI 17-27{\%}), P = 0.3578, or in non-punctured discs in the PD group (35{\%}, 95{\%} CI 21-51{\%}) compared with corresponding discs in the Control group (34{\%}, 95{\%} CI 27-42{\%}), P = 0.1169. There were no differences in disc-to-CSF T2 signal-intensity ratio, presence of disc herniations, HIZs, or Modic changes following puncture in the PD versus matched cohort discs or in the non-punctured PD cohort discs versus corresponding control cohort discs (P > 0.05).Conclusion. Patients with symptomatic LBP who underwent low-pressure PD, but who did not undergo a subsequent spinal fusion surgery, developed disc degeneration and new disc herniations at a similar rate to corresponding discs in matched control patients.",
keywords = "accelerated disc degeneration, chronic low back pain, disc abnormalities, disc herniation, disc stimulation, discogenic pain, fluoroscopic guidance, magnetic resonance imaging, Pfirrmann score, provocation discography, symptomatic low back pain",
author = "McCormick, {Zachary L.} and Lehman, {Vance T} and Plastaras, {Christopher T.} and Walega, {David R.} and Paul Huddleston and Charbel Moussallem and Geske, {Jennifer R.} and Verdoorn, {Jared T.} and Kennedy, {David J.} and Timothy Maus and Carrie Carr",
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language = "English (US)",
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pages = "E1161--E1168",
journal = "Spine",
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TY - JOUR

T1 - Low-Pressure Lumbar Provocation Discography According to Spine Intervention Society/International Association for the Study of Pain Standards Does Not Cause Acceleration of Disc Degeneration in Patients with Symptomatic Low Back Pain

T2 - A 7-Year Matched Cohort Study

AU - McCormick, Zachary L.

AU - Lehman, Vance T

AU - Plastaras, Christopher T.

AU - Walega, David R.

AU - Huddleston, Paul

AU - Moussallem, Charbel

AU - Geske, Jennifer R.

AU - Verdoorn, Jared T.

AU - Kennedy, David J.

AU - Maus, Timothy

AU - Carr, Carrie

PY - 2019/10/1

Y1 - 2019/10/1

N2 - Study Design. Retrospective matched cohort study. Objective. To determine if low-pressure lumbar provocation discography (PD) results in long-term accelerated disc degeneration, internal disc disruption, or disc herniation in patients with symptomatic low back pain (LBP).Summary of Background Data. Study of subjects without clinically-significant LBP suggests that high-pressure PD may accelerate disc degeneration. Methods. Consecutive patients with symptomatic LBP who underwent magnetic resonance imaging (MRI), PD, and repeat MRI more than 7 years later, but did not undergo subsequent spinal fusion surgery, were included. Punctured discs were matched (1:2 to 1:4) to corresponding discs in a control cohort by age, BMI, Pfirrmann score (±2), and presence of disc herniation; control cohort inclusion required MRIs for symptomatic LBP, separated by more than 7 years. The primary outcome of the study was a progression in Pfirrmann score category (I-II, III-IV, V). MRI disc-to-CSF T2 signal-intensity ratio, disc height, disc herniations, high intensity zones (HIZs), and Modic changes were assessed. Results. Baseline and follow-up MRIs were available for 77 discs exposed to PD, and for 260 discs in the matched control cohort. There was no difference in the proportion of punctured discs that advanced in Pfirrmann score category in the PD group (17%, 95% CI 9-27%) compared with corresponding discs in the Control group (21%, 95% CI 17-27%), P = 0.3578, or in non-punctured discs in the PD group (35%, 95% CI 21-51%) compared with corresponding discs in the Control group (34%, 95% CI 27-42%), P = 0.1169. There were no differences in disc-to-CSF T2 signal-intensity ratio, presence of disc herniations, HIZs, or Modic changes following puncture in the PD versus matched cohort discs or in the non-punctured PD cohort discs versus corresponding control cohort discs (P > 0.05).Conclusion. Patients with symptomatic LBP who underwent low-pressure PD, but who did not undergo a subsequent spinal fusion surgery, developed disc degeneration and new disc herniations at a similar rate to corresponding discs in matched control patients.

AB - Study Design. Retrospective matched cohort study. Objective. To determine if low-pressure lumbar provocation discography (PD) results in long-term accelerated disc degeneration, internal disc disruption, or disc herniation in patients with symptomatic low back pain (LBP).Summary of Background Data. Study of subjects without clinically-significant LBP suggests that high-pressure PD may accelerate disc degeneration. Methods. Consecutive patients with symptomatic LBP who underwent magnetic resonance imaging (MRI), PD, and repeat MRI more than 7 years later, but did not undergo subsequent spinal fusion surgery, were included. Punctured discs were matched (1:2 to 1:4) to corresponding discs in a control cohort by age, BMI, Pfirrmann score (±2), and presence of disc herniation; control cohort inclusion required MRIs for symptomatic LBP, separated by more than 7 years. The primary outcome of the study was a progression in Pfirrmann score category (I-II, III-IV, V). MRI disc-to-CSF T2 signal-intensity ratio, disc height, disc herniations, high intensity zones (HIZs), and Modic changes were assessed. Results. Baseline and follow-up MRIs were available for 77 discs exposed to PD, and for 260 discs in the matched control cohort. There was no difference in the proportion of punctured discs that advanced in Pfirrmann score category in the PD group (17%, 95% CI 9-27%) compared with corresponding discs in the Control group (21%, 95% CI 17-27%), P = 0.3578, or in non-punctured discs in the PD group (35%, 95% CI 21-51%) compared with corresponding discs in the Control group (34%, 95% CI 27-42%), P = 0.1169. There were no differences in disc-to-CSF T2 signal-intensity ratio, presence of disc herniations, HIZs, or Modic changes following puncture in the PD versus matched cohort discs or in the non-punctured PD cohort discs versus corresponding control cohort discs (P > 0.05).Conclusion. Patients with symptomatic LBP who underwent low-pressure PD, but who did not undergo a subsequent spinal fusion surgery, developed disc degeneration and new disc herniations at a similar rate to corresponding discs in matched control patients.

KW - accelerated disc degeneration

KW - chronic low back pain

KW - disc abnormalities

KW - disc herniation

KW - disc stimulation

KW - discogenic pain

KW - fluoroscopic guidance

KW - magnetic resonance imaging

KW - Pfirrmann score

KW - provocation discography

KW - symptomatic low back pain

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U2 - 10.1097/BRS.0000000000003085

DO - 10.1097/BRS.0000000000003085

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JO - Spine

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