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Provocative discography screening improves surgical outcome

Einfluss der provokativen Diskographie auf die klinische Behandlung von Patienten mit chronischen Kreuzschmerzen

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Summary

Objective

The objective of this study was to compare the surgical outcomes of patients operated on, with or without discography prior to operation.

Methods

The study was designed as a randomized controlled trial, using power analysis with McNemar’s test on two correlated proportions. The study comprised of 310 patients divided into trial (207) and control (103) groups. Inclusion criteria were low back pain resistant to nonsurgical treatment for more than 6 months and conventional radiological findings showing degenerative changes without a clear generator of pain. Exclusion criteria were red flags (tumor, trauma, and infection). After standard radiological diagnostic imaging (X-ray, CT, and MR), patients filled in the Oswestry Disability Index (ODI), SF-36, Zung, and MSP questionnaires. Depending on their radiological findings, patients were included and randomly placed in the trial or control group. At the 1-year follow-up examination, patients filled in the ODI, SF-36, and Likert scale questionnaires.

Results

The difference between preoperative and postoperative ODI in the control group degenerative disc disease (DDD) subgroup was 22.07 %. The difference between preoperative and postoperative ODI in the trial group DDD subgroup was 35.04 %. Differences between preoperative and postoperative ODI in the control group other indications subgroup was 26.13 %. Differences between preoperative and postoperative ODI in the trial group other indications subgroup was 28.42 %.

Conclusions

DDD treated surgically without discography did not reach the clinically significant improvement of 15 ODI points for the patients treated with fusion. Provocative discography screening with psychological testing in the trial group made improvement following fusion clinically significant.

Zusammenfassung

Einleitung

Ziel dieser Arbeit war der Vergleich der Ergebnisse der chirurgischen Behandlung von Patienten nach Diskographie und ohne Diskographie.

Methoden

Laut dem Ergebnis der Analyse der Teststärke wurden 310 Personen in die randomisierte, prospektiv kontrollierte Studie eingeschlossen, welche in eine Prüf- (207) und eine Kontrollgruppe (103) eingeteilt wurden. Einschlusskriterien waren Kreuzschmerzen, die nach 6 Monaten auf die chirurgische Behandlung nicht angesprochen hatten, sowie radiologische Ergebnisse, die degenerative Veränderungen zeigten ohne klare Schmerzursache. Ausschlusskriterien waren Tumor, Trauma, Entzündung und Schwangerschaft sowie frühere Operationen der Wirbelsäule. Nach der RTG-Diagnostik (der LS-Wirbelsäule, CT, MRT) haben die Patienten den Oswestry-Test (ODI), SF-36, Zung- und MSPQ-Test ausgefüllt. Abhängig vom RTG-Befund wurden die Patienten in die Studie eingeschlossen und in die Prüf- und Kontrollgruppe randomisiert. Im Laufe eines einjährigen postoperativen Follow-up haben sie ODI, SF-36 und Likert-Fragebögen ausgefüllt.

Ergebnisse

Der Unterschied zwischen dem prä- und postoperativen ODI in der Kontrollgruppe, Untergruppe DDD, betrug 22,07 %. Der Unterschied zwischen dem prä- und postoperativen ODI in der Prüfgruppe, Untergruppe DDD, betrug 34,04 %. Der Unterschied zwischen dem prä- und postoperativen ODI in der Kontrollgruppe, Untergruppe der anderen Indikation, betrug 26,13 %. Der Unterschied zwischen dem prä- und postoperativen ODI in der Prüfgruppe, Untergruppe der anderen Indikation, betrug 28,42 %.

Schlussfolgerung

Bei der degenerativen Diskuskrankheit (DDD) kam es bei der Behandlung mittels chirurgischer Fusion der Diskographie nicht zur statistisch bedeutenden Besserung von 15 ODI-Punkten. Die provokative Diskographie mit psychologischer Untersuchung ergab eine wesentliche Verbesserung des Ergebnisses der chirurgischen Behandlung bei den Patienten mit DDD.

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Conflict of interest

The authors declare that there is no conflict of interest.

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Authors and Affiliations

  1. Department of Radiology, Clinic for Traumatology, University Hospital Sisters of Mercy, Draskoviceva 19, 10000, Zagreb, Croatia

    Petra Margetic MD, PhD &  Roman Pavic MD, PhD

  2. School of Medicine, J. J. Strossmayer, Osijek, Croatia

    Roman Pavic MD, PhD

  3. School of Medicine, The University of Zagreb, Zagreb, Croatia

    Marin F. Stancic MD, PhD

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  1. Petra Margetic MD, PhD
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  2. Roman Pavic MD, PhD
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  3. Marin F. Stancic MD, PhD
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Correspondence to Petra Margetic MD, PhD.

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Margetic, P., Pavic, R. & Stancic, M. Provocative discography screening improves surgical outcome. Wien Klin Wochenschr 125, 600–610 (2013). https://doi.org/10.1007/s00508-013-0404-5

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