A study of clinical predictors of lumbar provocation discography
(English)Manuscript (preprint) (Other academic)
Discography is the only available method of directly challenging the discs for pain sensitivity. However, it Is invasive, expensive and there is debate about its clinical value. There Is a need to identify clinical signs that may indicate the need for a discography examination. Pain centralization (retreat of referred pain to towards the spinal midline) has been associated with positive discography and recently has been shown to possess speclflclty between 80 and 100% depending on levels of disablement and psychosocial distress. Centralization can only be elicited during a repeated movement examination, and cannot be tolerated by a proportion of patients. There is a need to identify other predictors besides centralization.
To estimate diagnostic accuracy for clinical variables in relation to discography.
Study design / setting
A blinded, prospective reference standard design in a private interventional radiology clinic in Louisiana.
Chronic low back patients receiving discography were examined (N=118) with 107 unconfounded cases being used to calculate diagnostic accuracy. Patients were typically disabled with high levels of psychosocial distress.
Diagnosis: results of provocation discography. Index tests: history, questionnaire and physical examination variables.
A detailed clinical examination was followed by lumbar provocation discography. Logistic regression modeling identified potentially useful clinical variables, and sensitivity, specificity and likelihood ratios were calculated for promising specific variables.
Unconfounded discography was achieved in 107 patients. History of persistent pain between acute episodes, a significant loss of extension and a subjective report of 'vulnerability' in what is termed the 'neutral zone' produced likelihood ratios between 2.0 and 4.1.
Three clinical variables have modest predictive power in relation to lumbar discography results and may be helpful in selection of patients for discography.
Chronic low back pain, Diagnosis, Discography, Physical examination Physiotherapy, Sensitivity, Specificity
Medical and Health Sciences
IdentifiersURN: urn:nbn:se:liu:diva-84266OAI: oai:DiVA.org:liu-84266DiVA: diva2:558406