The ability of pressure-controlled discography to predict surgical and nonsurgical outcomes.

STUDY DESIGN: A multicenter, retrospective study of long-term surgical and nonsurgical patient outcomes, after lumbar discography. OBJECTIVES: To investigate the efficacy and surgical outcome predictive value of categorizing positive discography findings, using a pressure x pain provocation categorization system. BACKGROUND: With the use of pressure-controlled manometric discography, improved and more specific diagnostic categorization is possible. The literature suggests that more specific categorization of positive discographic findings may predict surgical and nonsurgical outcomes. Studies have shown that intertransverse fusions may not fully protect the disc from anterior loading. Consequently, in patients who have low-pressure-sensitive discs, surgery that includes interbody fusion should provide a more favorable long-term outcome than intertransverse fusion only. METHODS: Long-term outcome was ascertained in 96 patients who had lumbar discography and subsequently underwent interbody fusion alone, combined fusion, intertransverse fusion or no surgery. Patients were retrospectively placed into specific diagnostic categories, according to a four-point scale. Progressively restrictive subgroups, beginning with the entire sample and ending with the most sensitive group (chemically sensitive), were examined for long-term surgical outcome differentiation. RESULTS: There were no significant differences in long-term surgical outcome across the entire sample. However, significant outcome differences existed across the subgroup of patients with chemically sensitive discs. In this group, patients undergoing interbody/combined fusion had a significantly better outcome than patients who had intertransverse fusion. Nonsurgical patients had the worst outcome overall. CONCLUSIONS: Patients with highly (chemically) sensitive discs appear to achieve significantly better long-term outcomes with interbody/combined fusion than with intertransverse fusion. Patients without disc surgery have the least favorable outcome. Precise prospective categorization of positive discographic diagnoses may predict outcomes from treatment, surgical or otherwise, thereby greatly facilitating therapeutic decision-making.