The ability of pressure-controlled discography to predict surgical and nonsurgical outcomes

Study Design. A multicenter, retrospective study of long-term surgical and nonsurgical patient outcomes, after lumbar discography. Objectives. To investigate the efficacy and surgical outcome predictive val ue of categorizing positive discography findings, using a pressure x pain p rovocation categorization system. Background. With the use of pressure-controlled manometric discography, imp roved and more specific diagnostic categorization is possible. The literatu re suggests that more specific categorization of positive discographic find ings may predict surgical and nonsurgical outcomes. Studies have shown that intertransverse fusions may not fully protect the disc from anterior loadi ng. Consequently, in patients who have low-pressure-sensitive discs, surger y that includes interbody fusion should provide a more favorable long-term outcome than intertransverse fusion only. Methods, Long-term outcome was ascertained in 96 patients who had lumbar di scography and subsequently underwent interbody fusion alone, combined fusio n, intertransverse fusion or no surgery. Patients were retrospectively plac ed into specific diagnostic categories, according to a four-point scale. Pr ogressively restrictive subgroups, beginning with the entire sample and end ing with the most sensitive group (chemically sensitive), were examined for long-term surgical outcome differentiation. Results. There were no significant differences in longterm surgical outcome across the entire sample. However, significant outcome differences existed across the subgroup of patients with chemically sensitive discs. In this g roup, patients undergoing interbody/combined fusion had a significantly bet ter outcome than patients who had intertransverse fusion. Nonsurgical patie nts had the worst outcome overall. Conclusions. Patients with highly (chemically) sensitive discs appear to ac hieve significantly better long-term outcomes with interbody/combined fusio n than with intertransverse fusion. Patients without disc surgery have the least favorable outcome. Precise prospective categorization of positive dis cographic diagnoses may predict outcomes from treatment, surgical or otherw ise, thereby greatly facilitating therapeutic decision-making.