scholarly journals An Update of the Appraisal of the Accuracy of Thoracic Discography as a Diagnostic Test for Chronic Spinal Pain

2012 ◽  
Vol 6;15 (6;12) ◽  
pp. E757-E776
Author(s):  
Vijay Singh
Keyword(s):  
Systematic Review ◽  
Intervertebral Disc ◽  
Diagnostic Accuracy ◽  
Facet Joint ◽  
Task Force ◽  
Relevant Literature ◽  
Thoracic Pain ◽  
Level Of Evidence ◽  
Discogenic Pain

Background: Even though the prevalence of thoracic pain has been reported to be 13% of the general population and up to 22% of the population in interventional pain management settings, the role of thoracic discs as a cause of chronic thoracic and extrathoracic pain has not been well studied. The intervertebral discs, zygapophysial or facet joints, and other structures including the costovertebral and costotransverse joints have been identified as a source of thoracic pain. Study Design: A systematic review of provocation thoracic discography. Objective: To systematically assess and update the quality of clinical studies evaluating the diagnostic accuracy of provocation thoracic discography. Methods: A systematic review of the literature was performed to assess the diagnostic accuracy of thoracic discography with respect to chronic, function limiting, thoracic or extrathoracic pain. The available literature on thoracic discography was reviewed. A methodological quality assessment of included studies was performed using Quality Appraisal of Reliability Studies (QAREL). The level of evidence was classified as good, fair, and limited (or poor) based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to June 2012, and manual searches of the bibliographies of known primary and review articles. Results: The evidence and clinical value of thoracic provocation discography is limited (poor) with a paucity of evidence, with only 2 studies meeting inclusion criteria. Limitations: The limitation of this study continues to be the paucity of literature. Conclusion: Based on the available evidence for this systematic review, due to limited evidence, thoracic provocation discography is rarely recommended for the diagnosis of discogenic pain in the thoracic spine, if conservative management has failed and facet joint pain has been excluded. Key words: Thoracic pain, chest wall pain, intervertebral disc, thoracic intervertebral disc, thoracic disc herniation, discogenic pain, thoracic provocation discography, falsepositive response, diagnostic accuracy

scholarly journals An Update of the Systematic Appraisal of the Accuracy and Utility of Lumbar Discography in Chronic Low Back Pain

2013 ◽  
Vol 2s;16 (2s;4) ◽  
pp. SE55-SE95
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Systematic Review ◽  
Back Pain ◽  
Intervertebral Disc ◽  
Diagnostic Accuracy ◽  
Chronic Back Pain ◽  
Task Force ◽  
International Association ◽  
Extensive Literature ◽  
Discogenic Pain

Background: The intervertebral disc has been implicated as a major cause of chronic lumbar spinal pain based on clinical, basic science, and epidemiological research. There is, however, a lack of consensus regarding the diagnosis and treatment of intervertebral disc disorders. Based on controlled evaluations, lumbar intervertebral discs have been shown to be the source of chronic back pain without disc herniation in 26% to 39% of patients. Lumbar provocation discography, which includes disc stimulation and morphological evaluation, is often used to distinguish a painful disc from other potential sources of pain. Despite the extensive literature, intense debate continues about lumbar discography as a diagnostic tool. Study Design: A systematic review of the diagnostic accuracy of lumbar provocation and analgesic discography literature. Objective: To systematically assess and re-evaluate the diagnostic accuracy of lumbar discography. Methods: The available literature on lumbar discography was reviewed. A methodological quality assessment of included studies was performed using the Quality Appraisal of Reliability Studies (QAREL) checklist. Only diagnostic accuracy studies meeting at least 50% of the designated inclusion criteria were included in the analysis. However, studies scoring less than 50% are presented descriptively and critically analyzed. The level of evidence was classified as good, fair, and limited or poor based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to September 2012, and manual searches of the bibliographies of known primary and review articles. Results: Over 160 studies were considered for inclusion. Of these, 33 studies compared discography with other diagnostic tests, 30 studies assessed the diagnostic accuracy of discography, 22 studies assessed surgical outcomes for discogenic pain, and 3 studies assessed the prevalence of lumbar discogenic pain. The quality of the overall evidence supporting provocation discography based on the above studies appears to be fair. The prevalence of internal disc disruption is estimated to be 39% to 42%, whereas the prevalence of discogenic pain without assessing internal disc disruption is 26%. Conclusion: This systematic review illustrates that lumbar provocation discography performed according to the International Association for the Study of Pain (IASP) criteria may be a useful tool for evaluating chronic lumbar discogenic pain. Key words: Lumbar intervertebral disc, lumbar discography, provocation discography, analgesic discography, diagnostic accuracy

scholarly journals Systematic Review of Thoracic Discography as a Diagnostic Test for Chronic Spinal Pain

2008 ◽  
Vol 5;11 (10;5) ◽  
pp. 631-642
Author(s):  
Vijay Singh
Keyword(s):  
Systematic Review ◽  
Intervertebral Disc ◽  
Diagnostic Accuracy ◽  
The United States ◽  
Facet Joints ◽  
Thoracic Pain ◽  
Level Of Evidence ◽  
Discogenic Pain ◽  
Weak Recommendation ◽  
Methodologic Quality

Background: Even though the prevalence of thoracic pain has been reported to be 15% of the general population and up to 22% of the population in interventional pain management settings, the role of thoracic discs as a cause of chronic thoracic and extrathoracic pain has not been well researched. The intervertebral discs, zygapophysial or facet joints, and other structures including the costovertebral and costotransverse joints have been identified as a source of thoracic pain. Objective: To systematically assess the quality of clinical studies evaluating the diagnostic accuracy of provocation thoracic discography. Study Design: A systematic review of provocation thoracic discography. Methods: A systematic review of the literature was performed to assess the diagnostic accuracy of thoracic discography with respect to chronic, function limiting, thoracic or extrathoracic pain. Studies meeting the Agency for Healthcare Research and Quality (AHRQ) methodologic quality criteria with scores of 50 or higher were included for the assessment of the level of evidence. Level of evidence was based on the United States Preventive Services Task Force (USPSTF) criteria for the assessment of accuracy of diagnostic studies. Based on the level of evidence, recommendations were made according to Guyatt et al’s criteria. Results: The clinical value of thoracic provocation discography is limited (Level II-3) with 2C/weak recommendation derived from low quality or very low quality evidence indicating that other alternatives may be equally reasonable. Conclusion: Based on the available evidence for this systematic review, thoracic provocation discography is provided with a weak recommendation for the diagnosis of discogenic pain in the thoracic spine, if conservative management has failed. This is qualified by the need to appropriately evaluate and diagnose other causes of chronic thoracic pain including pain originating from thoracic facet joints. Key words: Thoracic pain, chest wall pain, intervertebral disc, thoracic intervertebral disc, facet joint, thoracic disc herniation, discogenic pain, lumbar provocation discography, cervical provocation discography, thoracic provocation discography, false-positive response, diagnostic accuracy

scholarly journals An Update of the Appraisal of the Accuracy and Utility of Cervical Discography in Chronic Neck Pain

2012 ◽  
Vol 6;15 (6;12) ◽  
pp. E777-E806 ◽  
Author(s):  
Obi Onyewu
Keyword(s):  
Systematic Review ◽  
Neck Pain ◽  
Diagnostic Accuracy ◽  
Methodological Quality ◽  
Task Force ◽  
Preventive Services ◽  
Chronic Neck Pain ◽  
Accuracy Evaluation ◽  
Inclusion Criteria ◽  
Level Of Evidence

Background: Chronic neck pain represents a significant public health problem. Despite high prevalence rates, there is a lack of consensus regarding the causes or treatments for this condition. Based on controlled evaluations, the cervical intervertebral discs, facet joints, and atlantoaxial joints have all been implicated as pain generators. Cervical provocation discography, which includes disc stimulation and morphological evaluation, is occasionally used to distinguish a painful disc from other potential sources of pain. Yet in the absence of validation and controlled outcome studies, the procedure remains mired in controversy. Study Design: A systematic review of the diagnostic accuracy of cervical discography. Objective: To systematically evaluate and update the diagnostic accuracy of cervical discography. Methods: The available literature on cervical discography was reviewed. Methodological quality assessment of included studies was performed using Quality Appraisal of Reliability Studies (QAREL). Only diagnostic accuracy studies meeting at least 50% of the designated inclusion criteria were utilized for analysis. However, studies scoring less than 50% are presented descriptively and analyzed critically. The level of evidence was classified as good, fair, and limited or poor based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to June 2012, and manual searches of the bibliographies of known primary and review articles. Results: A total of 41 manuscripts were considered for accuracy and utility of cervical discography in chronic neck pain. There were 23 studies evaluating accuracy of discography. There were 3 studies meeting inclusion criteria for assessing the accuracy and prevalence of discography, with a prevalence of 16% to 53%. Based on modified Agency for Healthcare Research and Quality (AHRQ) accuracy evaluation and United States Preventive Services Task Force (USPSTF) level of evidence criteria, this systematic review indicates the strength of evidence is limited for the diagnostic accuracy of cervical discography. Limitations: Limitations include a paucity of literature, poor methodological quality, and very few studies performed utilizing International Association for the Study of Pain (IASP) criteria. Conclusion: There is limited evidence for the diagnostic accuracy of cervical discography. Nevertheless, in the absence of any other means to establish a relationship between pathology and symptoms, cervical provocation discography may be an important evaluation tool in certain contexts to identify a subset of patients with chronic neck pain secondary to intervertebral disc disorders.

scholarly journals Diagnostic Accuracy of Thoracic Facet Joint Nerve Blocks: An Update of the Assessment of Evidence

2012 ◽  
Vol 4;15 (4;8) ◽  
pp. E483-E496
Author(s):  
Sairam Atluri
Keyword(s):  
Systematic Review ◽  
Back Pain ◽  
Pain Relief ◽  
Diagnostic Accuracy ◽  
Local Anesthetic ◽  
Joint Pain ◽  
Facet Joint ◽  
Facet Joints ◽  
Thoracic Pain ◽  
Nerve Blocks

Background: Chronic mid back and upper back pain caused by thoracic facet joints has been reported in 34% to 48% of the patients based on their responses to controlled diagnostic blocks. Systematic reviews have established moderate evidence for controlled comparative local anesthetic blocks of thoracic facet joints in the diagnosis of mid back and upper back pain. Objective: To determine the diagnostic accuracy of thoracic facet joint nerve blocks in the assessment of chronic upper back and mid back pain. Study Design: Systematic review of the diagnostic accuracy of thoracic facet joint nerve blocks. Methods: A methodological quality assessment of included studies was performed using Quality Appraisal of Reliability Studies (QAREL). Only diagnostic accuracy studies meeting at least 50% of the designated inclusion criteria were utilized for analysis. Studies scoring less than 50% are presented descriptively and critically analyzed. The level of evidence was classified as good, fair, and limited (or poor) based on the quality of evidence developed by the United States Preventive Services Task Force (USPSTF). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to March 2012, and manual searches of the bibliographies of known primary and review articles. Outcome Measures: Controlled placebo or local anesthetic blocks were utilized using at least 50% pain relief as the reference standard. Results: Three studies were identified utilizing controlled comparative local anesthetic blocks, with ≥50% pain relief as the criterion standard. The evidence is good for the diagnosis of thoracic pain of facet joint origin with controlled diagnostic blocks. Limitations: The limitations of this systematic review include a paucity of literature for the diagnosis of thoracic facet joint pain, with all included manuscripts originating from one group of authors. Conclusions: Based on this systematic review, the evidence for the diagnostic accuracy of thoracic facet joint injections is good. Key words: Chronic thoracic pain, mid back or upper back pain, thoracic facet or zygapophysial joint pain, facet joint nerve blocks, medial branch blocks, controlled comparative local anesthetic blocks

scholarly journals Systematic Review of Discography as a Diagnostic Test for Spinal Pain: An Update

2007 ◽  
Vol 1;10 (1;1) ◽  
pp. 147-164
Author(s):  
Ricardo M. Buenaventura
Keyword(s):  
Systematic Review ◽  
Intervertebral Disc ◽  
Diagnostic Accuracy ◽  
Spinal Pain ◽  
Evaluation Tool ◽  
Discogenic Pain ◽  
Imaging Tool ◽  
Pain Generator ◽  
Chronic Spinal Pain

Background: The intervertebral disc has been implicated as an etiology of chronic spine pain based on clinical, basic science, and epidemiological research. There is currently no way to determine with absolute certainty whether or not the disc is a spinal pain generator. At our current level of understanding, discography is thought of as the best tool to evaluate disc-related pain. Study Design: A systematic review. Objective: To systematically assess the diagnostic accuracy of discography with respect to chronic spinal pain. Methods: A systematic review of the literature was performed to assess the diagnostic accuracy of discography with respect to chronic spinal pain. Study inclusion/exclusion criteria were based on the modern practice of discography. Selected studies were then subjected to two rating instruments for diagnostic accuracy studies (AHRQ and QUADAS). Specific data were then culled from these studies and tabulated. Evidence was then classified into five levels: conclusive, strong, moderate, limited, or indeterminate. Results: Evidence is strong for the diagnostic accuracy of discography as an imaging tool. Evidence is also strong for the ability of discography to evoke pain. There is strong evidence supporting the role of discography in identifying that subset of patients with lumbar discogenic pain. There is moderate evidence supporting the role of discography in identifying a subset of patients with cervical discogenic pain. There is limited evidence supporting the role of discography in identifying a subset of patients with thoracic discogenic pain. Conclusion: Discography is a useful imaging and pain evaluation tool in identifying a subset of patients with chronic spinal pain secondary to intervertebral disc disorders. Key words: Spinal pain, intervertebral disc, discography, pain generator, false-positives, diagnostic accuracy

scholarly journals Effectiveness of Thermal Annular Procedures in Treating Discogenic Low Back Pain

2017 ◽  
Vol 6 (20;6) ◽  
pp. 447-470 ◽  
Author(s):  
Standiford Helm
Keyword(s):  
Systematic Review ◽  
Task Force ◽  
Relevant Literature ◽  
Functional Improvement ◽  
Low Back ◽  
High Quality ◽  
Discogenic Pain ◽  
Term Efficacy ◽  
Discogenic Low Back Pain ◽  
Level I

Background: Discogenic low back is a distinct clinic entity characterized by pain arising from a damaged disc. The diagnosis is clouded by the controversy surrounding discography. The treatment options are limited, with unsatisfactory results from both conservative treatment and surgery. Multiple interventional therapies have been developed to treat discogenic pain, but most have not yet been validated by high quality studies. The best studied treatment for discogenic pain is the use of heat, which has been labeled as thermal intradiscal procedures (TIPs) by the Centers for Medicare and Medicaid Services (CMS). As the pathology is located in the annulus, we use the term thermal annular procedures (TAPs). Objectives: The aim of this study is to evaluate and update the efficacy of TAPs to treat chronic refractory discogenic pain. Study Design: The design of this study is a systematic review. Methods: The available literature on TAPs in treating chronic refractory discogenic pain was reviewed. The quality of each article used in this analysis was assessed. The level of evidence was classified on a 5-point scale from strong, based upon multiple randomized controlled trials (RCTs) to weak, based upon consensus, as developed by the US Preventive Services Task Force (USPSTF) and modified by the American Society of Interventional Pain Physicians (ASIPP). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to September 2015 and manual searches of the bibliographies of known primary and review articles. The primary outcome measures were pain relief and functional improvement of at least 40%. Short-term efficacy was defined as improvement for less than 6 months; long-term efficacy was defined as improvement for 6 months or more. Results: For this systematic review, 49 studies were identified. Of these, there were 4 RCTs and no observational studies which met the inclusion criteria. Based upon 2 RCTs showing efficacy, with no negative trials, there is Level I, or strong, evidence of the efficacy of biacuplasty in the treatment of chronic, refractory discogenic pain. Based upon one high-quality RCT showing efficacy and one moderate-quality RCT interpreted as showing no benefit, there is Level III, or moderate, evidence supporting the use of intradiscal electrothermal therapy (IDET) in treating chronic, refractory discogenic pain. The evidence supporting the use of discTRODE is level V, or limited. Conclusion: The evidence is Level I, or strong, that percutaneous biacuplasty is efficacious in the treatment of chronic, refractory discogenic pain. Biacuplasty may be considered as a first-line treatment for chronic, refractory discogenic pain.The evidence is Level III, or moderate, that IDET is efficacious in the treatment of chronic, refractory discogenic pain. The evidence is Level V, or limited, that discTRODE is efficacious in the treatment of chronic, refractory discogenic pain.

scholarly journals An Update of the Systematic Appraisal of the Accuracy and Utility of Discography in Chronic Spinal Pain

2018 ◽  
Vol 1 (21;1) ◽  
pp. 91-110 ◽  
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Systematic Review ◽  
Intervertebral Disc ◽  
Diagnostic Accuracy ◽  
Quality Assessment ◽  
Methodological Quality ◽  
Spinal Pain ◽  
Inclusion Criteria ◽  
Discogenic Pain ◽  
Level I ◽  
Chronic Spinal Pain

Background: The intervertebral disc has been implicated as a major cause of chronic spinal pain based on clinical, basic science, and epidemiological research. There is, however, a lack of consensus regarding the diagnosis and treatment of intervertebral disc disorders. Based on controlled evaluations, lumbar intervertebral discs have been shown to be the source of chronic back pain without disc herniation in 26% to 39% of patients, and in 16% to 53% of patients with pain in the cervical spine. Lumbar, cervical, and thoracic provocation discography, which includes disc stimulation and morphological evaluation, is often used to distinguish a painful disc from other potential sources of pain. Despite the extensive literature on point, intense debate continues about lumbar discography as a diagnostic tool. Study Design: A systematic review of the diagnostic accuracy of lumbar, cervical, and thoracic provocation and analgesic discography literature. Objective: To systematically assess and re-evaluate the diagnostic accuracy of lumbar, cervical, and thoracic discography. Methods: The available literature on discography was reviewed. A methodological quality assessment of included studies was performed using the Quality Appraisal of Reliability Studies (QAREL) checklist. Only diagnostic accuracy studies meeting at least 50% of the designated inclusion criteria were included in the analysis. To assess the level of evidence, a modified grading of qualitative evidence criteria was utilized, with grading of evidence into 5 categories from Level I to Level V incorporating evidence obtained from multiple high quality diagnostic accuracy studies for Level I and opinion or consensus of a large group of clinicians and/or scientists for Level V. Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to June 2017, and manual searches of the bibliographies of known primary and review articles. Results: Over 100 manuscripts were considered for inclusion. Of these, 8 studies met inclusion criteria for diagnostic accuracy and prevalence with 5 studies assessing lumbar provocation discography and 3 studies assessing cervical discography. The results showed variable prevalence from 16.9% to 26% for discogenic pain and 16.9% to 42% for internal disc disruption. The cervical discogenic pain prevalence ranged from 16% to 53%. Based on methodological quality assessment criteria the strength of evidence for lumbar provocation discography is Level III and for cervical discogenic pain is Level IV. Limitations: Despite multiple publications in the lumbar spine, value and validity of discography continues to be debated. In reference to cervical and thoracic discography, the available literature and value and validity continues to be low. Conclusion: This systematic review illustrates that lumbar provocation discography performed according to the International Association for the Study of Pain (IASP) criteria may be a useful tool for evaluating chronic lumbar discogenic pain. The evidence is weaker for cervical and nonexistent for thoracic discography. Key words: Lumbar intervertebral disc, cervical intervertebral disc, thoracic intervertebral disc, discography, provocation discography, analgesic discography, diagnostic accuracy, prevalence

scholarly journals Systematic Review of Cervical Discography as a Diagnostic Test for Chronic Spinal Pain

2009 ◽  
Vol 2;12 (2;3) ◽  
pp. 305-321
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Systematic Review ◽  
Neck Pain ◽  
Diagnostic Accuracy ◽  
False Positive ◽  
Public Health Problem ◽  
Accuracy Evaluation ◽  
Level Of Evidence ◽  
Discogenic Pain ◽  
Methodologic Quality ◽  
Level Ii

Background: Chronic neck pain represents a significant public health problem. Despite high prevalence rates, there is a lack of consensus regarding the causes or treatments for this condition. Based on controlled evaluations, the cervical intervertebral discs, facet joints, and atlantoaxial joints have all been implicated as pain generators. Cervical provocation discography, which includes disc stimulation and morphological evaluation, is often used to distinguish a painful disc from other potential sources of pain. Yet in the absence of validation and controlled outcome studies, the procedure remains mired in controversy. Study Design: A systematic review of the cervical discography literature. Objective: To evaluate the validity and usefulness of cervical provocation discography in managing and diagnosing discogenic pain by means of a systematic review. Methods: Following a comprehensive search of the literature, selected studies were subjected to a modified Agency for Healthcare Research and Quality (AHRQ) diagnostic accuracy evaluation. Qualitative analysis was conducted using 5 levels of evidence, ranging from Level I to III with 3 subcategories in Level II. The rating scheme was modified to evaluate the diagnostic accuracy. Results: A systematic review of the literature demonstrated that cervical discography plays a significant role in selecting surgical candidates and improving outcomes, despite concerns regarding the false-positive rate, lack of standardization, and assorted potential confounding factors. Based on the studies utilizing the International Association for the Study of Pain (IASP) criteria, the data show a prevalence rate ranging between 16% and 20%. Based on the 3 studies that utilized IASP criteria during the performance of cervical discography, the evidence derived from studies evaluating the diagnostic validity of the procedure, the indicated level of evidence is Level II-2 based on modified U.S. Preventive Services Task Force (USPSTF) criteria. Limitations: Limitations include a paucity of literature, poor methodologic quality, and very few studies performed utilizing IASP criteria. Conclusion: Cervical discography performed according to the IASP criteria may be a useful tool for evaluating chronic cervical pain, without disc herniation or radiculitis. Based on a modified AHRQ accuracy evaluation and USPSTF level of evidence criteria, this systematic review indicates the strength of evidence as Level II-2 for diagnostic accuracy of cervical discography. Key words: Neck pain, headache, cervical discogenic pain, cervical intervertebral disc, cervical provocation discography, false-positive rates, diagnostic accuracy, outcomes, cervical facet joint pain, controlled diagnostic blocks

scholarly journals Systematic Review of Lumbar Discography as a Diagnostic Test for Chronic Low Back Pain

2009 ◽  
Vol 3;12 (3;5) ◽  
pp. 541-599
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Intervertebral Disc ◽  
Diagnostic Accuracy ◽  
Chronic Low Back Pain ◽  
Low Back ◽  
Level Of Evidence ◽  
Methodologic Quality ◽  
Level Ii

Background: The intervertebral disc has been implicated as an etiology of chronic lumbar spine pain based on clinical, basic science, and epidemiological research. However, there is lack of consensus regarding the diagnosis and treatment of intervertebral disc disorders. Based on controlled evaluations, the lumbar intervertebral discs have been shown to be sources of chronic back pain without disc herniation in 26% to 39%. Lumbar provocation discography, which includes disc stimulation and morphological evaluation, is often used to distinguish a painful disc from other potential sources of pain. Despite the extensive literature, controversy continues about provocation lumbar discography. Study Design: A systematic review of the lumbar provocation discography literature. Objectives: To systematically assess the diagnostic accuracy of lumbar discography. Methods: A systematic review of the literature was performed to assess the diagnostic accuracy of lumbar discography with respect to chronic low back pain. Study inclusion/exclusion criteria were based on International Association for the Study of Pain (IASP) standards with pain provocation and determination of controlled discs. Selected studies were then subjected to a rating instrument for diagnostic accuracy studies. Specific data were then culled from these studies and tabulated. Quality of evidence was assessed using modified Agency for Healthcare Research and Quality (AHRQ) diagnostic accuracy evaluation. Studies meeting methodologic quality criteria scores of 50 or higher were included in the assessment of the level of evidence. Qualitative analysis was conducted using 5 levels of evidence, ranging from Level I to III, with 3 subcategories in Level II. The rating scheme was modified to evaluate the diagnostic accuracy. Results: Based on a modified U.S. Preventive Services Task Force (USPSTF) level of evidence criteria, this systematic review indicates the strength of evidence as Level II-2 for the diagnostic accuracy of lumbar provocation discography utilizing IASP criteria. Limitations: Limitations include a paucity of literature, poor methodologic quality, and very few studies performed utilizing IASP criteria. Conclusion: Based on the current systematic review, lumbar provocation discography performed according to the IASP criteria with control disc (s) with minimum pain intensity of 7 of 10, or at least 70% reproduction of worst pain (i.e. worst spontaneous pain of 7 = 7 x 70% = 5) may be a useful tool for evaluating chronic lumbar discogenic pain. Discography is an important imaging and pain evaluation tool in identifying a subset of patients with chronic low back pain secondary to intervertebral disc disorders. Key words: Chronic low back pain, lumbar intervertebral disc, lumbar discography, provocation discography, pain generator, false-positives, diagnostic accuracy, sensitivity, specificity

scholarly journals Reporting quality of diagnostic accuracy studies: a systematic review and meta-analysis of investigations on adherence to STARD

2013 ◽  
Vol 19 (2) ◽  
pp. 47-54 ◽  
Author(s):  
Daniël A Korevaar ◽  
W Annefloor van Enst ◽  
René Spijker ◽  
Patrick M M Bossuyt ◽  
Lotty Hooft
Keyword(s):  
Systematic Review ◽  
Diagnostic Accuracy ◽  
Meta Analysis ◽  
Reporting Quality
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