Wichman Heather J
St. Joseph Regional Medical Center, Medical Education Department, 5000 W Chambers St, Milwaukee, WI 53210, USA.
WMJ. 2007 Feb;106(1):27-9.
Low back pain is estimated to affect 80% of the general population at least once in their lifetime. It is the fifth leading cause of medical clinic visits and the leading work-related disability. Lumbar discography has been used to diagnose the source of low back pain when non-invasive imaging, such as magnetic resonance (MR), does not reveal morphologic abnormality consistent with symptoms. Controversy regarding the usefulness of discography has been ongoing for over 50 years. Modern advancements with imaging and technique still have not been sufficient to justify the practicality of this procedure for standard use. Based on review of current literature, pain provoked by discography of normal appearing discs on MR were likely due to internal disc disruption, increased pain sensitivity, and false positive result with chronic pain, psychological state, central hyperalgia, and technical difficulty of the procedure. These causes of positive pain provocation are not amendable to invasive treatment. In these cases, an invasive diagnostic procedure to identify problems best treated with conservative management is not practical. The conclusion of this review found no clear evidence-based purpose for discography in the diagnosis and treatment of low back pain.
据估计，80%的普通人群一生中至少会经历一次腰痛。它是门诊就诊的第五大主要原因，也是与工作相关残疾的首要原因。当非侵入性成像（如磁共振成像（MR））未显示与症状相符的形态学异常时，腰椎间盘造影已被用于诊断腰痛的来源。关于椎间盘造影有用性的争议已经持续了50多年。成像和技术方面的现代进展仍不足以证明该程序常规使用的实用性。根据对当前文献的综述，MR上外观正常的椎间盘进行椎间盘造影引发的疼痛可能是由于椎间盘内部破裂、疼痛敏感性增加以及慢性疼痛、心理状态、中枢性痛觉过敏和该程序的技术难度导致的假阳性结果。这些疼痛激发阳性的原因不适用于侵入性治疗。在这些情况下，采用侵入性诊断程序来识别最适合保守治疗的问题是不实际的。本综述的结论发现，在腰痛的诊断和治疗中，没有明确的循证依据支持椎间盘造影。
