Automated Pressure-Controlled Discography in Patients Undergoing Anterior Lumbar Interbody Fusion for Discogenic Back Pain

Chang Kyu Lee; Dong Ah Shin; Hyoung Ihl Kim; Seong Yi; Yoon Ha; Keung Nyun Kim; Do Heum Yoon

doi:10.1016/j.wneu.2016.09.019

Automated Pressure-Controlled Discography in Patients Undergoing Anterior Lumbar Interbody Fusion for Discogenic Back Pain

World Neurosurg. 2017 Jan:97:8-15. doi: 10.1016/j.wneu.2016.09.019. Epub 2016 Sep 16.

Authors

Chang Kyu Lee¹, Dong Ah Shin², Hyoung Ihl Kim³, Seong Yi⁴, Yoon Ha⁴, Keung Nyun Kim⁴, Do Heum Yoon⁴

Affiliations

¹ Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea; Department of Neurosurgery, Keimyung University Dongsan Medical Center, Daegu, Korea.
² Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea; Department of Medical System Engineering, Gwangju Institute of Science and Technology, Gwangju, Korea. Electronic address: cistern@yuhs.ac.
³ Department of Medical System Engineering, Gwangju Institute of Science and Technology, Gwangju, Korea.
⁴ Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea.

PMID: 27647031
DOI: 10.1016/j.wneu.2016.09.019

Abstract

Study design: Retrospective cohort study.

Objective: To compare the clinical outcomes of patients undergoing anterior lumbar interbody fusion (ALIF) with or without automated pressure-controlled discography (APCD) before the procedure.

Methods: Patients (n = 36) who underwent ALIF for lumbar discogenic back pain between 2008 and 2013 and were followed for more than 6 months were enrolled in this study. APCD was performed to identify discogenic back pain. Preoperative x-rays, computed tomography images, and magnetic resonance images were obtained. The intervertebral disc height, type of Modic change, grade of disc degeneration, and fusion rate were determined. Additionally, the presence or absence of high-intensity zone and vacuum disc were checked preoperatively. Clinical evaluation was performed by visual analog scale (0 = no pain, 10 = worst pain imaginable), Oswestry Disability Index (ODI), and 36-Item Short Form Health Survey before surgery and every 6 months postoperatively.

Results: The average patient age was 53.3 years (range, 31-73 years). The mean follow-up durations were 19.7 months. Seventeen patients (the APCD-ALIF group) underwent ALIF after APCD, and 19 patients underwent ALIF without APCD. The APCD-ALIF group had significantly improved clinical outcomes compared with the control group (visual analog scale score 1.8 ± 1.6 vs. 3.3 ± 2.4; P = 0.039: ODI score 6.7 ± 6.3 vs. 12.1 ± 6.8; P = 0.019). The surgical improvement rate was significantly associated with ODI score (P = 0.005).

Conclusions: The results of this study confirm that APCD aids surgical outcomes of ALIF in patients with suspected lumbar discogenic pain. We recommend performing APCD before ALIF to confirm lumbar discogenic pain.

Keywords: Anterior lumbar interbody fusion; Automated pressure-controlled discography; Discogenic back pain; Discogram; Discography.

MeSH terms

Adult
Aged
Back Pain / diagnostic imaging*
Back Pain / etiology
Back Pain / surgery*
Female
Follow-Up Studies
Humans
Intervertebral Disc Degeneration / complications
Intervertebral Disc Degeneration / surgery*
Lumbar Vertebrae / surgery*
Magnetic Resonance Imaging
Male
Middle Aged
Pressure
Retrospective Studies
Severity of Illness Index
Spinal Fusion / methods*
Tomography, X-Ray Computed
Treatment Outcome
Visual Analog Scale