Anderson Joshua T, Haas Arnold R, Percy Rick, Woods Stephen T, Ahn Uri M, Ahn Nicholas U
Orthopedics. 2015 Nov;38(11):e951-8. doi: 10.3928/01477447-20151020-01.
Lumbar diskography (LD) is frequently used in the evaluation of patients with degenerative disk disease and diskogenic low back pain. Its safety and diagnostic accuracy are a topic of debate. No study has evaluated the efficacy of LD within the clinically distinct workers' compensation population. Within this setting, the authors wished to determine the effect of undergoing LD before diskogenic fusion on rates of postoperative failed back surgery syndrome (FBSS). Also, the authors compared opioid analgesic use between patients undergoing LD and patients not undergoing LD. ICD-9 diagnoses and CPT procedural codes were used to identify 1591 patients from the Ohio Bureau of Workers' Compensation who underwent diskogenic fusion between 1993 and 2013. A total of 682 patients underwent LD before fusion, which formed the LD group, with the remaining 909 patients as controls. The authors used a multivariate logistic regression analysis while correcting for relevant covariates. Diskography before fusion was a positive predictor of postoperative FBSS (P=.04; odds ratio, 1.44). The rate of FBSS was 13.9% of the LD group and 8.8% in the control group. Postoperatively, the LD group was supplied with a significantly higher daily opioid analgesic load (P=.04) for an average of 130 additional days (P<.01). Additional predictors of FBSS included the ability to remain at work within 1 week of index fusion (P=.02; odds ratio, 0.54), male sex (P=.03; odds ratio, 1.51), preoperative narcotic use for more than 1 year (P=.02; odds ratio, 1.53), and fusion technique (P=.03). Diskography should ideally help identify good candidates for lumbar fusion. However, the authors' study raises significant concerns regarding LD's current role within the workers' compensation population.
腰椎间盘造影术（LD）常用于评估退行性椎间盘疾病和盘源性下腰痛患者。其安全性和诊断准确性一直是争论的话题。尚无研究评估LD在临床特征明显的工伤赔偿人群中的疗效。在此背景下，作者希望确定在进行盘源性融合手术前接受LD对术后失败的脊柱手术综合征（FBSS）发生率的影响。此外，作者比较了接受LD的患者和未接受LD的患者之间阿片类镇痛药的使用情况。使用国际疾病分类第九版（ICD-9）诊断代码和现行程序术语（CPT）手术代码，从俄亥俄州工人赔偿局识别出1993年至2013年间接受盘源性融合手术的1591例患者。共有682例患者在融合手术前接受了LD，组成LD组，其余909例患者作为对照组。作者在对相关协变量进行校正的同时，使用了多因素逻辑回归分析。融合手术前的椎间盘造影术是术后FBSS的阳性预测指标（P = 0.04；比值比，1.44）。LD组的FBSS发生率为13.9%，对照组为8.8%。术后，LD组平均额外130天每天接受的阿片类镇痛药剂量显著更高（P = 0.04）（P<0.01）。FBSS的其他预测因素包括在初次融合手术1周内能够继续工作（P = 0.02；比值比，0.54）、男性（P = 0.03；比值比，1.51）、术前使用麻醉药超过1年（P = 0.02；比值比，1.53）以及融合技术（P = 0.03）。理想情况下，椎间盘造影术应有助于识别适合腰椎融合手术的患者。然而，作者的研究引发了对LD在工伤赔偿人群中当前作用的重大担忧。
