An update of the systematic appraisal of the accuracy and utility of lumbar discography in chronic low back 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.

An assessment of a new navigatable percutaneous disc decompression device (l'DISQ) through histologic evaluation and thermo-mapping in human cadaveric discs.

Study Design: This is an in vitro experimental study of the technical capability and safety study of a navigable percutaneous disc decompression device named L'DISQ.

Objectives: The objectives of this study were to determine if L'DISQ could adequately reach certain target zones in the disc and to measure the distribution of rises in temperature in the surrounding tissue when the device was used to ablate the disc.

Methods: Placement of the wand of L'DISQ was attempted into the posterior annulus of the discs of four fresh human cadavers.

Functional anatomy and pathophysiology of axial low back pain: disc, posterior elements, sacroiliac joint, and associated pain generators.

Careful consideration of functional lumbosacral anatomy reveals the capacity for pain generation in the disc, zygapophysial joint, sacroiliac joint, and surrounding ligaments. However, the methods used to definitively implicate a particular anatomic structure in axial low back pain have limitations. Anatomically and biomechanically, the discs and posterior elements are inextricably connected to a dynamic biotensegrity network of ligaments, muscles, and fascia.

A critical review of the American Pain Society clinical practice guidelines for interventional techniques: part 1. Diagnostic interventions.

Background: Clinical guidelines are defined as systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. The clinical guideline industry has been erupting even faster than innovation in health care, constantly adding unhealthy perspectives with broad and complex mandates to health care interventions. Clinical guidelines are based on evidence-based medicine (EBM) and comparative effectiveness research (CER).

Evidence-based medicine, systematic reviews, and guidelines in interventional pain management: Part 7: systematic reviews and meta-analyses of diagnostic accuracy studies.

Appropriate diagnosis is essential in providing proper and effective therapy. The field of diagnostic accuracy tests is dynamic with new tests being developed at a fast pace along with improvement in technology of existing tests on a continuous basis. Well-designed diagnostic test accuracy studies can help in making appropriate health care decisions, provided that they transparently and fully report their participants, tests, methods, and results.

Comparison of growth factor and cytokine expression in patients with degenerated disc disease and herniated nucleus pulposus.

Objectives: This study was conducted to investigate the expression of cytokines and growth factors in disc specimens obtained from patients with herniated nucleus pulposus (HNP) and degenerated disc disease (DDD).

Design And Methods: MRI and Western blot analyses were performed to evaluate the levels of disc degeneration and the expression levels of cytokines and growth factors.

Results: The levels of TNF-alpha and IL-8 were significantly greater in the DDD group than in the HNP group, but no statistical differences were observed in the expression of IL-1beta, IL-6 and IL-12 between the HNP and DDD groups.

Systematic review of lumbar discography as a diagnostic test for chronic low back pain.

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%.

Evidence-based medicine, systematic reviews, and guidelines in interventional pain management: part 5. Diagnostic accuracy studies.

Diagnosis is a critical component of health care. The world of diagnostic tests is highly dynamic. New tests are developed at a fast pace and technology of existing tests is continuously being improved.

Are outer annular fissures stimulated during diskography the source of diskogenic low-back pain? An analysis of analgesic diskography data.

Objective: This study aimed to clarify whether painful annular fissures stimulated during provocation diskography are the likely source of diskogenic pain.

Design: A retrospective analysis was conducted of prospectively collected data.

Setting: Multidisciplinary, academic spine center.

Systematic review of lumbar provocation discography in asymptomatic subjects with a meta-analysis of false-positive rates.

Background: Lumbar provocation discography is a controversial diagnostic test. Currently, there is a concern that the test has an unacceptably high false-positive rate.

Study Design: Systematic review and meta-analysis.