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Provocative discography may lead to more imaging and back problems in long-term

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SAN FRANCISCO — Results of a 10-year matched cohort study showed patients who underwent provocative discography at three lower lumbar levels required more lumbar surgery at the 10-year follow-up than a control group who did not undergo discography, and these differences were considered statistically significantly different, according to a presenter here.

By the 5-year follow-up, patients in the discography cohort also required statistically significantly more imaging than the non-discography cohort, Michael P. Stauff, MD, said at the International Society for the Study of the Lumbar Spine Annual Meeting.

“There was a greater incidence in the discography cohort, and this increased at 10 years, making it 21 [imaging] events in the discography cohort and 11 imaging events in the control cohort,” he said. “Lumbar discography leads to more surgery, more imaging events, and more low back events and medical visits. Clinicians should counsel patients about the risk of clinical disc problems after provocative discography.”

Michael P. Stauff

The study was conducted to determine the clinical effects of provocative discography on the lumbar intervertebral disc. Seventy-five patients were included in each cohort at the outset, and neither group of patients had a significant history of low back pain at the time of enrollment.

Study findings showed there were more episodes of low back pain (LBP) that lasted 1 week, more lost work time and more medical visits for LBP in the discography than the control group at 10 years, according to Stauff.

Stauff noted that the loss of 40 study subjects overall due to attrition or exclusion, and the fact that both groups were inherently more prone to disc degeneration, were among the study’s limitations. – by Susan M. Rapp

Reference:

Cuellar JM, et al. Paper #36. Presented at: International Society for the Study of the Lumbar Spine Annual Meeting; June 8-12, 2015; San Francisco.

Disclosure: Stauff reports he receives research support from Pfizer and is a reviewer for The Spine Journal.