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%. 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

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Intervertebral disc therapies for non-specific chronic low back pain: a systematic review and meta-analysis

Therapeutic Advances in Musculoskeletal Disease ◽

10.1177/1759720x211028001 ◽

2021 ◽

Vol 13 ◽

pp. 1759720X2110280

Author(s):

Camille Daste ◽

Stéphanie Laclau ◽

Margaux Boisson ◽

François Segretin ◽

Antoine Feydy ◽

...

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Intervertebral Disc ◽

Chronic Low Back Pain ◽

Meta Analysis ◽

Activity Limitations ◽

Low Back ◽

Short Term

Objectives: We aim to evaluate the benefits and harms of intervertebral disc therapies (IDTs) in people with non-specific chronic low back pain (NScLBP). Methods: We conducted a systematic review and meta-analysis of randomized trials of IDTs versus placebo interventions, active comparators or usual care. EMBASE, MEDLINE, CENTRAL and CINHAL databases and conference abstracts were searched from inception to June 2020. Two independent investigators extracted data. The primary outcome was LBP intensity at short term (1 week–3 months), intermediate term (3–6 months) and long term (after 6 months). Results: Of 18 eligible trials (among 1396 citations), five assessed glucocorticoids (GCs) IDTs and were included in a quantitative synthesis; 13 assessed other products including etanercept ( n = 2), tocilizumab ( n = 1), methylene blue ( n = 2), ozone ( n = 2), chymopapaine ( n = 1), glycerol ( n = 1), stem cells ( n = 1), platelet-rich plasma ( n = 1) and recombinant human growth and differentiation factor-5 ( n = 2), and were included in a narrative synthesis. Standardized mean differences (95% CI) for GC IDTs for LBP intensity and activity limitations were −1.33 (−2.34; −0.32) and −0.76 (−1.85; 0.34) at short term, −2.22 (−5.34; 0.90) and −1.60 (−3.51; 0.32) at intermediate term and −1.11 (−2.91; 0.70) and −0.63 (−1.68; 0.42) at long term, respectively. Odds ratios (95% CI) for serious and minor adverse events with GC IDTs were 1.09 (0.25; 4.65) and 0.97 (0.49; 1.91). Conclusion: GC IDTs are associated with a reduction in LBP intensity at short term in people with NScLBP. Positive effects are not sustained. IDTs have no effect on activity limitations. Our conclusions are limited by high heterogeneity and a limited methodological quality across studies. Registration PROSPERO: CRD42019106336.

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SHORT-WAVE DIATHERMY IN PATIENTS WITH CHRONIC LOW BACK PAIN: A SYSTEMATIC REVIEW

Coluna/Columna ◽

10.1590/s1808-185120201903219301 ◽

2020 ◽

Vol 19 (3) ◽

pp. 218-222

Author(s):

LUIS HENRIQUE PALADINI ◽

NICOLE ALMEIDA ◽

RACIELE IVANDRA GUARDA KORELO ◽

RAFAEL MICHEL DE MACEDO ◽

LUIZ CESAR GUARITA-SOUZA ◽

...

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Short Wave ◽

Cochrane Central Register ◽

Low Back ◽

Level Of Evidence ◽

Pulsed Mode ◽

Central Register

ABSTRACT The aim of this study was to evaluate the evidence of application of short-wave diathermy (SWD) in individuals with chronic low back pain (CLBP) and its prescription parameters. The data sources (MEDLINE, PubMed, LILACS, DARE, PsycINFO, AusportMed, SciELO, PEDro and the Cochrane Central Register of Controlled Trials) were systematically searched for articles published up to December 2017. Randomized and non-randomized clinical trial studies that investigated the effect of the application of SWD on CLBP were selected. Two independent reviewers assessed the risk of bias in studies using the Jadad and the Downs & Black scales. Five studies (731 patients) were included, all of whom presented improvements in CLBP. The majority used continuous mode SWD, with only one using pulsed mode (82 and 200 Hz). SWD produced improvements in CLBP, but there is limited evidence for its application, and a lack of standardization of the parameters used. Furthermore, the results that address this topic should be interpreted with caution due to their low methodological quality and limited number. Level of evidence II; Systematic review.

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OP0102 INTERVERTEBRAL DISC THERAPIES FOR NON-SPECIFIC CHRONIC LOW BACK PAIN: A SYSTEMATIC REVIEW AND META-ANALYSIS

10.1136/annrheumdis-2019-eular.4492 ◽

2019 ◽

Author(s):

Camille Daste ◽

Stéphanie Laclau ◽

Margaux Boisson ◽

François Segretin ◽

Antoine Feydy ◽

...

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Intervertebral Disc ◽

Chronic Low Back Pain ◽

Meta Analysis ◽

Low Back

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Systematic Review of the Effectiveness of Thermal Annular Procedures in Treating Discogenic Low Back Pain

January 2018 - Pain Physician ◽

10.36076/ppj.2009/12/207 ◽

2009 ◽

Vol 1;12 (1;1) ◽

pp. 207-232 ◽

Cited By ~ 1

Author(s):

Standiford Helm II

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Outcome Measures ◽

Observational Studies ◽

Low Back ◽

Level Of Evidence ◽

Level Ii ◽

Discogenic Low Back Pain ◽

One Year

Background: Chronic discogenic low back pain is a common problem with significant personal and societal costs. Thermal annular procedures (TAPs) have been developed in an effort to provide a minimally invasive treatment for this disorder. Multiple techniques utilized are intradiscal electrothermal therapy (IDET), radiofrequency annuloplasty, and intradiscal biacuplasty (IDB). However, these treatments continue to be controversial, coupled with a paucity of evidence. Study Design: A systematic review of the literature evaluating the efficacy or effectiveness of TAPs. Objective: To determine the effectiveness of TAPs in reducing low back pain in patients with intradiscal disorders. Methods: A comprehensive evaluation of the literature relating to TAPs was performed. The literature was evaluated according to Cochrane Review criteria for randomized controlled trials (RCTs) and according to the Agency for Healthcare Research and Quality (AHRQ) criteria for observational studies. The level of evidence was classified as Level I, II, or III based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Pain relief was the primary outcome measure. Other outcome measures were functional improvement, improvement of psychological status, and return to work. Data sources included relevant literature of the English language identified through searches of PubMed, EMBASE, the Cochrane Library, and the Database of Reviews of Effectiveness (DARE). Outcome Measures: Short-term effectiveness was defined as one-year or less and long-term effectiveness was defined as greater than one-year. Results: Systematic review of IDET identified 2 RCTs and 16 observational studies with an indicated evidence of Level II-2. Systematic review of radiofrequency annuloplasty identified no RCTs but 2 observational studies with an uncertain evidence of Level II-3. Systematic review of IDB identified one pilot study. The level of evidence is lacking with Level III. Limitations: The limitations of this review include paucity of the literature and lack of evidence with internal validity and generalizability. Conclusion: IDET offers functionally significant relief in approximately one-half of appropriately chosen chronic discogenic low back pain patients. There is minimal evidence supporting the use of radiofrequency annuloplasty and IDB. Key words: Chronic low back pain, degenerative disc disease, internal disc disruption, intervertebral disc, thermal annular procedures, intradiscal electrothermal therapy, radiofrequency ablation, intradiscal biacuplasty, radiofrequency annuloplasty

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