Center for Sports Medicine and Orthopaedics, Chattanooga, Tennessee;
J Neurosurg Spine. 2014 Jul;21(1):37-41. doi: 10.3171/2014.4.SPINE14269.
Identifying the etiology of pain for patients suffering from chronic low-back pain remains problematic. Noninvasive imaging modalities, used in isolation, have not consistently provided sufficient evidence to support performance of a lumbar fusion. Provocative testing has been used as an adjunct in this assessment, either alone or in combination with other modalities, to enhance the diagnostic capabilities when evaluating patients with low-back pain. There have been a limited number of studies investigating this topic since the publication of the original guidelines. Based primarily on retrospective studies, discography, as a stand-alone test, is not recommended to formulate treatment strategies for patients with low-back pain. A single randomized cohort study demonstrated an improved potential of discoblock over discography as a predictor of success following lumbar fusion. It is therefore recommended that discoblock be considered as a diagnostic option. There is a possibility, based on a matched cohort study, that an association exists between progression of degenerative disc disease and the performance of a provocative discogram. It is therefore recommended that patients be counseled regarding this potential development prior to undergoing discography.
对于患有慢性下腰痛的患者，确定疼痛的病因仍然存在问题。单独使用的无创成像方式并未提供足够的证据支持进行腰椎融合术。在这种评估中，诱发性试验已被用作辅助手段，单独使用或与其他方式结合使用，以提高对下腰痛患者的诊断能力。自原始指南发布以来，针对该主题的研究数量有限。主要基于回顾性研究，椎间盘造影术作为一项独立的检查，不建议用于制定下腰痛患者的治疗策略。一项单中心随机队列研究表明，椎间盘造影阻断术作为腰椎融合术成功预测指标的潜在效果优于椎间盘造影术。因此，建议将椎间盘造影阻断术作为一种诊断选择。基于匹配队列研究，退行性椎间盘疾病的进展与诱发性椎间盘造影术之间可能存在关联。因此，建议在进行椎间盘造影术前向患者说明这种潜在的发展情况。
