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Todd Alamin, MD,a Farbod Malek, MD,a Eugene Carragee, MD,a
and Mi-Jung Kim, MD, PhDb
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BACKGROUND
The diagnostic evaluation of patients with presumed discogenic low back pain is
controversial; recent studies have brought the specificity of the traditional
technique, provocative lumbar discography, into question. One of the explanations
for the relative lack of predictability in treatment outcomes for patients with
discogenic low back pain may be a corresponding lack of certainty in the diagnosis.
PURPOSE
A new diagnostic technique is described for the evaluation of patients with
presumptive discogenic low back pain; the cases of 3 patients in whom the
technique was used are presented.
STUDY DESIGN/SETTING
Case report; university practice.
METHODS
A technique is described in which an anaesthetic catheter is placed into putative
symptomatic lumbar discs, the patient elicits
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his or her typical painvia a position or activity, and anaesthetic or placebo is delivered to the disc. The effect of
the injected substance on the patient’s pain is then noted.
RESULTS
In one patient, the new test was confirmatory of the results of the
provocative discogram; in two patients, the test results were divergent.
CONCLUSIONS
These case studies and technical description are presented as a first step
in examining this method of preoperative assessment. Further study of the
technique will allow us to make more definitive recommendations with regards
to its validity and utility.
LEVEL OF EVIDENCE
Level 4 – Case Series
Key Words:
Discography, functional anaesthetic discogram, discogenic pain, diagnosis. SAS Journal. Spring 2008;2:107113. DOI: SASJ-2007-0123-NT
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aOrthopaedics Surgery, Stanford University, Stanford, California; bPhysiatry Department, Hanyang University, Seoul, South Korea
Address correspondence to Todd Alamin, MD, Stanford University – Orthopaedic Surgery, 300 Pasteur Drive, Room R-171, Stanford, CA 92405.
This manuscript was submitted November 9, 2007, and accepted for publication February 2, 2008.
Todd Alamin, MD, is a consultant to Kyphon Inc.; Todd Alamin, MD, receives royalties from Kyphon in relation to the FAD catheter.
Institutional Review Board approval was obtained from Stanford University Medical Center.
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